Joint Pain Linked to Worse Quality of Life in Ulcerative Colitis Patients

ORLANDO -- More than a third of patients with ulcerative colitis also experienced debilitating joint pain, which can wreak havoc on their quality of life, a cross-sectional study showed.

Among 631 patients with gastrointestinal symptoms associated with ulcerative colitis, 36% reported that they also had painful joints, said Marlana Radcliffe, MD, of the University of North Carolina School of Medicine in Chapel Hill, during her poster presentation at the Advances in Inflammatory Bowel Diseases annual meeting.

After adjusting for demographics and disease characteristics, painful joints were associated with increased risks of depression (OR 2.13, 95% CI 1.37-3.32), anxiety (OR 2.12, 95% CI 1.44-3.11), fatigue (OR 4.58, 95% CI 3.06-6.92), and social impairment (OR 2.90, 95% CI 1.88-4.52).

"We have to be aware that patients have other things happening other than just with their gastrointestinal discomfort that also needs to be addressed," Radcliffe told MedPage Today. "Our findings support further research and clinical attention on addressing the extraintestinal manifestations of arthritis in ulcerative colitis patients. While gastroenterologists and clinical trial outcomes focus primarily on the gastrointestinal symptoms for ulcerative colitis, the systemic manifestations of disease are often debilitating for patients."

Commenting on the study, Svein-Oskar Frigstad, MD, PhD, of Vestre Viken Bærum Hospital and the University of Oslo in Norway, noted that "with inflammatory bowel disease, we are actually interested in the distress that occurs in our patients, even though this may not include problems in the gut."

"Joint pain is very common among our patients," he told MedPage Today. "Inflammatory bowel disease involves inflammation, and of course, pain in the joints is often caused by inflammation as well. So there are similarities there. ... And, of course, those symptoms of pain in the joint do have an effect on a patient's quality of life."

"We also see increases in bowel symptoms among patients who also have joint pain," he added. "While it's not the majority of patients with inflammatory bowel disease who also have joint pain, it is about one-third who have this problem."

Frigstad said that healthcare providers should be vigilant about asking patients about joint pain and medications used for that pain because it can cause problems with treatment for inflammatory bowel disease. "Generally, the medications taken to relieve joint pain can have an impact on the drugs that are taken to treat inflammatory bowel disease," he said. "Non-steroidal anti-inflammatory drugs often taken to relieve joint pain are known to increase inflammation in the gut. You may have to find other drugs to treat joint pain, or even move to a biologic, which may help both joint pain and inflammatory bowel disease."

For this study, Radcliffe and colleagues included 631 patients from IBD Partners, a patient-powered research network that sends surveys to patients biannually. They used the Patient-Reported Outcomes Measurement Information System (PROMIS) to assess quality of life.

Of the patients, mean age was 46, 90% were white, and 38% were on biologic therapy.

Among the patients who had experienced joint pain in the past week, mean age was 48 compared with a mean age of 45 for those who did not have joint pain in the previous week (P=0.04). Men outnumbered women in reporting joint pain in the past week (75% vs 25%). Participants with pain had a higher body mass index – 26.5 versus 24.6 for those who didn't have pain (P<0.001).

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