Joint Pain and Tenderness

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meowese
Regular Member


Date Joined Jan 2008
Total Posts : 121
   Posted 9/20/2008 11:26 AM (GMT -7)   
I know that certain kind(s) of arthritis are common with Crohn's and I complain of joint pain and muscle/skin tenderness all the time. My question is can any of these joint complaints (if associated with Crohn's) be dangerous in the long term or are they mostly harmless? Also my Crohn's is in remission... I'm not having stomach complaints although I frequently am deficient in something or another (recently Vit. D inexplicably). Do the 'side effects' of Crohn's usually persist despite the apparently being in remission?

For some background my left knee is often so tight that I can't straighten it after standing up without some discomfort. I had pain in my right shoulder that prevented me from using my arm for about a month, but my dad has bursitis so I just figured that's what it was... It eventually resolved on its own! I also get pain in my hips and my left foot will cramp up making me limp. Sometimes my muscles everywhere feel tender to the touch - if you poke me in the stomach or arm it'll hurt!

Thanks!
Crohn's (diagnosed in 2006 and currently in remission), severe migraines, Seborrheic Derm., Hemolytic Uremic Syndrome (1994), chronic pain, ulcers/GERD and possibly Lupus. Medications: Nexium, Pentasa, Percocet and Vicodin as needed, Flintstone Vitamins (my favorite part!), calcium and magnesium supplements, vitamin D once weekly. I follow a low fiber, low residue diet.

Post Edited (meowese) : 9/20/2008 12:51:33 PM (GMT-6)


Ides
Forum Moderator


Date Joined Nov 2003
Total Posts : 7077
   Posted 9/20/2008 9:12 PM (GMT -7)   
Your question -- My question is can any of these joint complaints (if associated with Crohn's) be dangerous in the long term or are they mostly harmless?

Depends on the type of arthritis issue. Some people with CD have developed rheumatoid arthritis which can cause lots of permanent damage. Others develop spondyloarthropathy assoicated with IBD. That too can cause permanent damage. Then there are those that develop the arthritis associated with CD flares. That type goes away when the CD is in remission and usually causes no long lasting problems/

The best thing you could do is go to a rheumatologist and get you joint pain evaluated. Since your CD is in remission, there is likely some other issue evolving. My CD is in remission and my ankylosing spondylitis is not. It causes me loads of trouble with my joints.
Moderator Crohn's Disease Forum
CD, Ankylosing Spondylitis, lupus, small fiber peripheral neuropathy, avascular necrosis, peripheral artery disease, degenerative disc disease, and a host of other medical problems.
 


Keeper
Veteran Member


Date Joined Jun 2008
Total Posts : 1058
   Posted 9/20/2008 10:24 PM (GMT -7)   
I wonder if there may be an underlying connection between the gut problems and the various other conditions associated with Crohn's. The connection between a permeable gut and AS has been made and there is evidence that elevated TNF levels causes tendon pain by interfering with the cellular repair mechanism. It may be that these conditions persist during what is usually called remission - both increased gut permeability and elevated TNF levels. I have found some success in reducing tendon pain by adopting a regime that is designed to reduce TNF and permeability. Tendon pain has persisted even while I am feeling no symptoms of Crohn's. I had no idea that Crohn's was involved and until I had a diagnosis, I was not able to resolve chronic and spreading tendon pain. I have added three supplements to the vitamins and minerals that I have been taking, all designed to control both gut permeability and TNF levels. First, a probiotic. Probiotics have been shown to reduce inflammation and TNF levels, so they were the starting point. Then, turmeric capsules (turmeric and bromelain was the capsule that I was able to find). Turmeric is well known as an anti-inflammatory agent and some research I read cited the ability to reduce a range of immune cascade products including TNF. Finally, Glutamine. Glutamine is known to help repair the mucosa and reduce gut permeability (in hamsters at least).

Gut permeability has been connected to almost every Crohn's related disease, including pancreatitis, gallstones, RA, AS, and probably others that I have not specifically tracked down research on. Why does the current medical protocol completely ignore gut permeability? It seems to be a serious oversight and I for one am going to do everything to reduce it that I can. The research on AS shows chronic elevated gut permeability, although I did not locate anything testing the potential for reducing permeability or the effects of reducing permeability on the progress of AS.

meowese
Regular Member


Date Joined Jan 2008
Total Posts : 121
   Posted 9/20/2008 10:50 PM (GMT -7)   
Thank you Ides and Keeper. I have an appointment with a new rheum on Monday so I'll try to address some of my problems with him.


---- Keeper I don't understand a lot of what you said lol! I want to but I am not very well versed in lots of Crohn's terminology and what things do. If you have time to explain it further, do you mind? Specifically I don't know anything about gut permeability and TNF at all.
Crohn's (diagnosed in 2006 and currently in remission), severe migraines, Seborrheic Derm., Hemolytic Uremic Syndrome (1994), chronic pain, ulcers/GERD and possibly Lupus. Medications: Nexium, Pentasa, Percocet and Vicodin as needed, Flintstone Vitamins (my favorite part!), calcium and magnesium supplements, vitamin D once weekly. I follow a low fiber, low residue diet.


Keeper
Veteran Member


Date Joined Jun 2008
Total Posts : 1058
   Posted 9/21/2008 6:03 PM (GMT -7)   
Gut permeability happens when the wall of the gut is disrupted by a variety of environmental factors. It means that the mucous membrane is not excluding large molecules and bacteria the way it is supposed to. Those molecules and bacteria can then enter the blood and provoke an immune reaction. In Crohn's, the immune reaction results in an attack on the gut bacteria with a lot of inflammation and D. The inflammation makes gut permeability worse and this continues the problem. Cronnies have a modified immune system and they tend to have stronger immune reactions and the immune reaction does not terminate as easily as it does for most people. One of the markers for the immune system's response is a molecule called Tumor Necrosis Factor so called because it was originally thought to be responsible for killing cancer cells. In Crohn's, TNF levels are usually elevated in the blood, indicating the existence of gut inflammation due to an immune system reaction. Drugs like Humira and Remicade inhibit the production of TNF and that accounts for their ability to stop inflammation of the gut. Permeability and TNF are not directly connected, but both are involved in the causing of an array of other effects - what I called Crohn's related disease

Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 9/21/2008 6:29 PM (GMT -7)   
Hey Keeper I love many of your posts but I too have hard time understanding what you are saying. You speak too much medicalese so to say. I have had this disease for over 30 years and know alot about it to but your medical terminology sometimes is over the top. I think what you are trying to say is important, so can you try to explain things more in laymens terms? Also, are you a doctor or something?

Thanks
Gail *Nanners*
Been living with Crohn's Disease for 32 years.  Currently on Asacol, Prilosec 60 mg, Estrace, Prinivil, Diltiazem, Percoset prn for pain and Calcium.  Resections in 2002 and 2005.  Recently diagnosed with Fibromyalgia and doing tests to see if I have Inflammatory Arthritis or AS.


Keeper
Veteran Member


Date Joined Jun 2008
Total Posts : 1058
   Posted 9/21/2008 11:17 PM (GMT -7)   
Sorry, I thought that I was being fairly basic - at least by comparison to the research papers that I have been getting this stuff from. No, I am not a doctor, just a chemistry grad with an understanding of the kind of language that is used in writing technical documents. I'll try again.

The first step in the sequence of events leading to Crohn's symptoms is the development of gut permeability. The known causes of relapse in Crohn's all cause gut permeability. They include - gut infections (abscess, food poisoning, ulcers and so on); stress (plain old everyday stress); non-steriodal anti-inflammatories or NSAIDs (aspirin, ibuprofen and different brands and formulations containing those); Alcohol; and a number of others including foods that cause allergic responses (they make you sick or cause pain).
What happens when you have increased gut permeability is that the contents of your gut can leak into the blood and surrounding tissue. The first result is an immune reaction against bacteria and foreign proteins. The immune reaction against gut bacteria results in your system attacking the bacteria in the gut and causing inflammation and D - just like you had food poisoning (food poisoning is caused by eating food that has bacteria that attack your gut - usually something like salmonella). That is the first round of effects.
The gut bacteria are numerous and somewhat isolated from the immune response both by being outside the blood and tissue of the body and by possessing the ability to neutralize the body's immune response. This makes the immune response only partially effective at killing off gut bacteria. For most people, the immune response kills off bacteria in the body/blood and then shuts down by restoring the mucous membrane which isolates the gut contents from the more active parts of the immune system. In Crohn's, the immune reaction does not stop normally and can be more severe than is normal. This results in chronic inflammation and damage to the gut caused by the ongoing immune reaction. Most treatment for Crohn's is aimed at reducing inflammation, but almost no effort is made to help gut permeability. If gut permeability continues or happens again, the problem can begin again and again.

One of the body's immune system molecules that are part of the response to bacteria caused by gut bacteria leaking out of the gut is TNF (tumor necrosis factor - sorry for the tech-speak - just think of it as a sign pointing out that there is gut inflammation). TNF is targeted by humira and remicade.

Anyway, what happens when the gut bacteria leak out? Besides starting an immune response, gut bacteria are able to travel through the blood to places like the liver. There, they have been shown to cause gallstones. Next, once the immune system starts killing off those bacteria and also those remaining in the gut, the dead bacteria release poisons called endotoxins. The liver normally removes toxins like that from the blood, but it may be unable to handle the large amount of toxins from the huge reservoir of bacteria in the gut. The toxins cause you to feel sick - tired and brain fogged - it is the same as the feeling you get when you have a serious infection or flu - which also cause blood toxins to accumulate. Endotoxins are directly damaging to your pancreas and if you come down with pancreatitis, it is confirmation that you have continuing gut inflammation, immune attack on gut bacteria and continuing gut permeability. More later - too late to keep on now.

Keeper
Veteran Member


Date Joined Jun 2008
Total Posts : 1058
   Posted 9/22/2008 1:23 PM (GMT -7)   
In near relatives of Crohn's patients, gut permeability can precede the development of Crohn's in that relative by 8 years, suggesting that permeability is involved in the development of the disease.
Gut permeability and TNF are connected. TNF is associated with increased permeability even when there is no visible evidence of disease. This raises the question of whether the TNF causes permeability or permeability causes TNF production.
Aids that have been shown to reduce permeability are glutamine capsules and zinc supplements (25 mg of zinc daily).

Another factor is stress. Stress has been shown to activate Mast cells which are one of the first cells to respond to foreign proteins. They cause allergic reactions and are thought to be the cause of RA. They would also be connected to the appearance of rashes and itchy skin. It may be that the mast cell response initiates the immune cycle that causes gut permeability and elevated TNF levels.
Another paper reports that TNF prevents the tendon's cells (tenocytes) from being able to repair damage. This means that as long as you have gut inflammation (which generates TNF) even without active signs of Crohn's, your tendons will be vulnerable to damage and unable to recover normally. It would feel like chronic tendonitis. This may be most of the joint pain that results from Crohn's and is a sign that you have uncontrolled inflammation, even if you have little to no gut symptoms or even visible gut lesions in a colonoscopy. I suspect that this mechanism is also responsible for throat and sinus irritation, but I have no confirmation of this.
Aids for reducing TNF include probiotics (Lactobacillus bacteria, especially L. casei) and turmeric capsules. The probiotic should have a number of different species in the formula and supplements that require refrigeration are preferable. I would recommend an enteric coated supplement if possible. Turmeric capsules may be formulated with bromelain (a digestive enzyme source) for joint pain reduction. This looks like a good combination and has had positive results for me.

Finally, I recently read of a Crohn's patient who was given a drug that stimulated his stem cell production (G-CSF) and then blood was drawn and the blood (containing stem cells) was treated to remove the cells that maintain acquired immune responses (CD4 T cells). He was then treated to destroy his immune cells and his stored stem cells were returned. This resulted in a complete remission of Crohn's symptoms for a period of 9 months with no medication. It is rather like the treatment for leukemia, with some differences. See: http://www.nature.com/bmt/journal/v32/n3/full/1704134a.html
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