Inflammation of the Joints, Skin, and Eyes
Reviewed by: HU Medical Review Board | Last Reviewed: January 2018.
Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, causes chronic inflammation of the digestive tract. However, many people have inflammation and symptoms outside the digestive tract, too. These are called "extraintestinal manifestations" of IBD. The joints, skin, and eyes are commonly affected.
Between 6% and 47% of people with IBD have symptoms outside the digestive tract.1 You are at higher risk if you have perianal disease or inflammation in the colon. Smokers and people with a family history of IBD are at higher risk. Having one extraintestinal manifestation increases the chances of a second.1
No one is exactly sure what causes extraintestinal symptoms. IBD seems to develop when the immune system overreacts to the microorganisms in your digestive tract.2,3 The job of white blood cells is to fight infection. White blood cells travel to the intestine to fight harmless microorganisms. Some of the white blood cells stay in the intestine and cause lasting inflammation.3 Other white blood cells leave the intestine. They travel to other parts of the body, where they cause inflammation.1 Not every person with IBD has symptoms outside the digestive tract. Therefore, researchers think that genetics have a role.1
Sometimes, joint, skin, or eye conditions are related to medications or nutrient deficiencies. For example, using corticosteroids for a long time is linked to having cataracts. Trouble absorbing vitamin A could lead to night blindness.1
About 35% of people with IBD have joint inflammation.1 The joints are the most common parts to be affected outside the digestive tract. The severity and type of joint inflammation varies. Inflammation can affect joints in the arms and legs. This is called peripheral arthritis. Inflammation can also affect the spine, which is called axial arthritis.
Type I peripheral arthritis. In this type of arthritis, fewer than 5 joints are affected. The pain gets worse during flares and better during remission. The inflammation usually goes away on its own in about 10 weeks. Treating the underlying bowel disease improves the joint pain. Type I peripheral arthritis does not cause lasting damage to the joints.1Type II peripheral arthritis.In this type of arthritis, 5 or more joints are affected. This kind of joint inflammation does not necessarily happen at the same time as intestinal inflammation. Unfortunately, the pain and inflammation can last for years. Your health care provider may recommend having an ultrasound.1 The ultrasound can reveal signs of inflammation in the lining of the joint. Treatment includes physical therapy and medications. Various medications are used, including anti-inflammatories and COX-2 pain relievers.
Spinal (axial) arthritis. Inflammation can affect the spine, causing back pain or morning stiffness.1 Spinal inflammation does not necessarily happen at the same time as intestinal inflammation. There is a strong link between a condition called “ankylosing spondylitis” and inflammatory bowel disease. Ankylosing spondylitis is a disorder in which the spinal joints (vertebrae) become inflamed. In some cases, the joints start to fuse together.1 Your health care provider may recommend magnetic resonance imaging (MRI). The MRI will reveal early signs of inflammation, before the joints become deformed.1 Spinal arthritis is treated with physical therapy, COX-2 pain relievers, and sometimes biologic medications.1
Between 9% and 19% of people with IBD have skin symptoms.1Erythema nodosum.This condition causes painful red growths under the skin.1 The growths are often on the front of the lower legs. They can also appear on the torso, arms, neck, or face. Erythema nodosum is the most common skin manifestation of IBD, affecting about 10% to 15% of people with IBD. Women are at greater risk than men. The growths appear during disease flares. Treating the underlying inflammatory bowel disease also treats the growths. This skin condition does not cause lasting ulcers or scars. Elevating your legs, wearing compression stockings, and taking pain relievers can reduce some of the discomfort.1Pyoderma gangrenosum. This condition is a rare and serious skin manifestation. It causes deep, painful, open sores. The sores often form on the legs or in the location where you have had a puncture, cut, or biopsy. These sores do cause scarring. Smaller sores are treated with topical medications. For large sores, treatments include systemic corticosteroids, immunosuppressants, and biologic medications.1Sweet’s syndrome. This condition is also rare. Painful red lesions appear on the arms, neck, face, and back during a flare of IBD.4 You may have a fever. Corticosteroids are used to treat the lesions.1 These lesions do not leave scars.
IBD can also cause eye inflammation, ranging from mild to severe.1 About 2% to 6% of people with IBD have eye symptoms.
Mild inflammation can irritate the thin outer layers of the eye. This condition is called conjunctivitis or episcleritis, depending on which layer is inflamed. The white parts of your eye will hurt and appear pink. Treating the underlying bowel inflammation usually treats the eye inflammation.
Severe inflammation affects deeper layers of the eye. Scleritis is inflammation of the white outer wall of the eye. Anterior uveitis is an infection of the middle layer of the eye, which contains the colored part (iris). Severe inflammation is treated with corticosteroids or immunosupressants. Without treatment, this kind of inflammation could lead to blindness.1