Do you sometimes feel like this? When you wake up in the morning, your joints hurt and feel swollen... Along with that, you have an upset stomach and need to go to the toilet several times a day. If you have both of these symptoms at the same time, you may need to be aware of a condition called enteropathic arthritis.
What is Enteropathic Arthritis?
Simply put, enteropathic arthritis is a condition that causes pain and swelling in your joints (arthritis) along with inflammation in your digestive system, or intestines (Inflammatory Bowel Disease - IBD) . Imagine having a problem with both at once. Some people call this enteropathic arthropathy, or IBD-related arthropathy.
Now, look, when we say arthritis, we all know that it's a condition that causes swollen, painful joints, and can be chronic . On the other hand, when we say IBD, it means that there's a long-term inflammation or injury that occurs in part or all of your digestive tract, especially your intestines. So, if you have EnA, you have pain and swelling in these joints, but also inflammation in your intestines.
EnA belongs to a larger group of diseases that affect the joints. It's called spondyloarthropathy. It's a complicated name, but it refers to a long-term disease of the joints. This condition can be a bit of a barrier to your normal life , but the good news is that there are treatments for it.
What are the symptoms of enteropathic arthritis (EnA)?
For someone with EnA, the main effects are on your joints and digestive system (Gastrointestinal - GI system).
Joint-related symptoms:
These usually affect the joints in your hands and feet the most, but sometimes these pains and discomforts can also occur in your back .
- Changes in the shape of the joints: For example, the fingers may appear to be drawn out, or they may appear to be knobby.
- Skin discoloration: The skin over the joint may become red and discolored.
- Pain: This is the main symptom.
- Joint stiffness/stiffness: Upon waking up in the morning, you may feel difficulty in bending or extending your joints for a while.
- Swelling: The joints appear swollen and enlarged.
- Tenderness: Pain when touching or pressing on the joint.
- Joint warmth: The area where the joint is located feels warmer than other areas.
Symptoms related to the digestive system (GI system):
- Stomach ache: Frequent stomach aches.
- Blood in the stool when going to the toilet: This is a symptom that you should be very concerned about.
- Frequent diarrhea: Going to the bathroom several times a day.
- Unintentional weight loss: It's not that you're trying hard to lose weight, it's just that you're losing weight.
Some people may experience GI symptoms first, then joint symptoms . Or it may be the other way around. That is, the joints start to hurt first, then the stomach issues start. Sometimes both symptoms can flare up at the same time.
Why does enteropathic arthritis (EnA) develop? What are the causes?
In fact, scientists still haven't figured out exactly what causes EnA . But they suspect that a protein called HLA-B27 , found on the surface of our white blood cells, is involved.
Think of it this way, because of this `HLA-B27` protein, our body's immune system sometimes mistakenly starts attacking our own healthy cells, especially the cells in our joints . It's like our own army attacking itself.
But there's something else here. This `HLA-B27` is not unique to this disease. That is, not everyone who is `HLA-B27` positive will develop enteropathic arthritis. Some healthy people can also be positive for it. So, although this could be a factor, it is still something that is still in the research stage .
Who is at higher risk of developing enteropathic arthritis (EnA)?
It is estimated that about one in five people with inflammatory bowel disease (IBD) will develop enteropathic arthritis. IBD mainly includes conditions such as ulcerative colitis and Crohn's disease .
In addition, EnA can be associated with other conditions that affect your small intestine . For example:
- Celiac disease: This is also an autoimmune condition. This means that the body's immune system attacks its own cells.
- Inflammation that occurs after bacterial infections such as Salmonella and Shigella. Some bacterial infections can also cause inflammation of the intestines, which can lead to joint problems.
- Some intestinal surgeries (intestinal bypass surgery).
- Whipple disease: This is a relatively rare bacterial infection.
How do doctors diagnose this?
When you go to see a doctor with these symptoms, the first thing he or she will do is give you a complete physical examination . Then, they will take a good look at your personal health history . They will also ask you a lot of questions about your symptoms. In particular, they will ask you questions about how your joint pain changes throughout the day, such as whether it is worse in the morning or at night .
They will also ask about your digestive system (GI) symptoms , such as changes in bowel habits and loss of appetite.
Additionally, it is important to know your family's medical history , especially if anyone in your family has had IBD or arthritis.
What tests are used to diagnose enteropathic arthritis (EnA)?
There is no specific test to diagnose EnA. However, your doctor may order several tests to confirm that you have both IBD and arthritis, or to rule out other causes for your symptoms. These tests may include:
- Arthrocentesis: This involves taking a small sample of a fluid called synovial fluid from your joint and testing it . This can provide information about inflammation in the joint.
- Taking a sample of your stool and doing a bacterial culture test.
- A biopsy is a test that involves taking a piece of tissue from the digestive system.
- Blood tests that show inflammation: For example, erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) tests. These can give an idea of whether there is swelling or inflammation somewhere in the body.
- A blood test for `HLA-B27` .
- Colonoscopy: This is a test that examines the large intestine using a tube with a camera.
- X-rays of joints that are painful or tender to the touch.
How is enteropathic arthritis (EnA) treated?
The main goal of enteropathic arthritis treatment is to reduce the discomfort in your digestive system as well as the discomfort in your joints . It is also important to prevent further damage to the joints .
The following can be used as treatment options:
- Glucocorticoids injections: These help reduce pain and swelling. They can also be injected directly into the joint.
- Disease-modifying antirheumatic drugs (DMARDs): These drugs work by changing the way your immune system works, slowing the progression of the disease. Examples include methotrexate , sulfasalazine , hydroxychloroquine, and leflunomide .
- Tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors): This is another powerful class of drugs that affect the immune system. An example is Infliximab .
- Physical therapy: This is very helpful in maintaining good joint function and preventing joint damage and deformity.
- Surgery: In some severe cases, especially if there are back problems, surgery may be necessary.
- Lifestyle changes: It is very important to be careful, especially with what you eat and drink (diet) .
How do I take care of my health with enteropathic arthritis (EnA)?
Although EnA can affect your daily life, there are several ways to help you feel better and function better :
- Applying heat to painful joints can help relax muscles. Similarly, applying cold can help reduce joint pain. Some people find heat helpful, while others find cold helpful. Find out what works best for you.
- Choose anti-inflammatory foods and drinks. That means cutting down on spicy and oily foods and adding more vegetables, fruits, and herbs to your diet.
- Practice good posture. That is, stand up straight when sitting and standing.
- Participate in support groups. Talking to others who have conditions like arthritis or IBD can be a great source of strength and information.
- If you smoke or use tobacco products, stop. These can make symptoms worse.
- Stretch and get regular physical activity. Ask your doctor what exercises are right for you and do them.
- Try complementary therapies, such as massage , meditation , acupuncture , guided imagery, and relaxation techniques . But it's a good idea to talk to your doctor before trying these.
What questions should I ask my doctor?
When you go to see the doctor, it will be helpful for you to ask questions like these:
- What kind of treatment do you recommend for me?
- Are there any special foods I should not eat?
- What can I do to prevent flare-ups?
- Can my children also get this condition? (That is, is it hereditary?)
Can enteropathic arthritis (EnA) be prevented?
Because scientists still don't fully understand what causes enteropathic arthropathy, there's no way to completely prevent the disease . However, there are ways you can help prevent symptom flare-ups .
You can focus on a healthy eating plan that includes plenty of fresh vegetables and fruits . Try to get some physical activity every day. If you smoke, definitely quit . Talk to your doctor about other ways you can reduce the frequency of these symptoms.
What is the prognosis for someone with enteropathic arthritis (EnA)?
The course of the disease in someone with EnA can vary greatly from person to person . Symptoms may be constant or come and go . Flare-ups can be a minor annoyance for some people, while for others they can be severe enough to disrupt their day.
But, the most important thing is that many people with enteropathic arthritis lead normal, productive lives and live normal lifespans .
Not only do you have joint pain, but now you have gut issues too? Enteropathic arthritis can be a really painful, life-threatening condition. Symptoms can vary, but when the condition is severe, it can affect your entire day. Fortunately, there are treatment options available . However, it can take some time to find the right treatment for you. You are unique, so your symptoms may not improve in the same way that someone else's symptoms improve. Talk to your doctor. He or she can help you develop a treatment plan that works best for you.
Things we should remember from this story (Take-Home Message)
Okay, so let's look at some simple things to remember about the enteropathic arthritis we talked about:
- EnA is a condition that occurs together with arthritis and inflammatory bowel disease (IBD) .
- Symptoms may include joint pain, swelling, and stiffness, as well as stomach cramps, diarrhea, and blood in the stool .
- The exact cause of this has not yet been found , but genetic factors such as `HLA-B27` may play a role.
- People with IBD (especially Crohn's disease and ulcerative colitis) are at higher risk of developing it.
- Various tests (blood, stool, colonoscopy, X-ray) are used to diagnose the disease.
- Medication, physical therapy, and lifestyle changes are important treatments.
- Although the disease cannot be completely prevented, it is possible to control the symptoms and live a good life .
- The most important thing is not to panic, but to talk to your doctor and get the treatment and advice that is best for you.
If you have these symptoms, don't suffer alone, but seek medical advice as soon as possible. Then you can get relief quickly.
` Enteropathic arthritis, arthritis, bowel disease, digestive tract, joint pain, IBD, Crohn's disease
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