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Inflammatory Bowel Disease
(Colitis, Crohn's) and Arthritis


Inflammatory Bowel Disease (IBD), which includes Crohn's and ulcerative colitis, can be a painful and debilitating condition. In addition to bowel symptoms, patients with IBD often experience extraintestinal complications, such as arthritis, kidney and liver disease, eye disorders and skin problems. Of these, arthritis is the most common - occurring in about 25% of all IBD sufferers.

Inflammatory bowel disease causes a whole range of inflammatory reactions in joints, sinews and vessels. This association can be easily explained by the fact that one of the functions of the GI tract is to rid the body of dangerous substances. If this protective barrier is damaged, toxic substances can enter the body and cause inflammatory and rheumatologic diseases. These antigens can collect in the synovial fluid of the joints, which can cause a local inflammatory response. They can also enter the bloodstream and cause a reaction from the immune system itself, leading to damage in joints and other tissues of the body. 

Unfortunately, Western medicine tends to separate different body systems without looking at their intricate relationships. Inflammatory bowel disease and arthritis are both auto-immune diseases. They need to be looked at as "co-existing" conditions that influence and contribute to one another, rather than two separate, unrelated illnesses. Only a thorough approach that addresses the causes of auto-immunity and recognizes the interaction of IBD and arthritis can ameliorate both diseases.




  • Ulcerative colitis patients are more likely to experience arthritis in their peripheral joints (limbs). 

  • In those with Crohn's disease, on the other hand, arthritis tends to develop in knees and ankle joints

  • Those suffering from diverticulitis rarely experience rheumatoid or ankylosing arthritis. Rather, diverticular disease often leads to peripheral small joint inflammation.

  • Patients with celiac disease (inability to digest gluten, a protein found in grains, like wheat, rye, barley, oats and corn) often suffer from symmetrical polyarthritis, which involves major joints - such as knees and ankles, along with hips and shoulders. This type of arthritis can appear before other symptoms of celiac disease in 50% of patients. Later, softening of the bones - also known as "osteomalacia" - can occur.

The incidence of arthritis in people with IBD is equal for men and women, and even children.


Arthritis may be a warning symptom of IBD
Often, arthritis can appear before the symptoms of IBD, especially in children with Crohn's disease. If your child develops arthritis, Crohn's should be considered, even if your child isn't yet experiencing any intestinal symptoms and occult stool tests are negative. 

Another form of arthritis called "spinal arthritis" - or spondylitis - can occur years before the onset of more common IBD symptoms, such as bloody diarrhea and abdominal pain. Spondylitis produces pain and stiffness in the lower spine and sacroiliac joints. A more sinister and rare form of spinal arthritis called "ankylosing spondylitis" can lead to inflammation of the eyes, lungs and heart valves. Both forms of spondylitis are serious illnesses that can severely limit your quality of life and lead to serious complications. It's important to seek timely treatment or better yet, try to prevent the onset of arthritis if you're at risk because you suffer from IBD.

Prevention is key for IBD sufferers
If you suffer from IBD - be it either ulcerative colitis or Crohn's disease - it's important to talk to a doctor about preventative measures you can take to avoid arthritis. As the saying goes - and it's particularly true in this case - the best offense is defense.

Clearly, people suffering from colitis and arthritis need to address both diseases. Otherwise, you'll be simply relieving symptoms rather than treating the underlying cause. For example, NSAIDs (non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen) along with steroid injections are often used to treat arthritis and lessen pain associated with it. But if you're an IBD sufferer - beware! NSAIDs can irritate your intestinal lining and lead to more inflammation. It's important that your treatment plan considers all aspects of both conditions.

If you're overweight, try to lose weight. Your diet should be modified according to your body needs, avoiding specific triggers that lead to your symptoms. Although you need to follow a special diet (i.e. gluten-free in celiac disease or meat-free in gout and other arthritic pain), it is important to keep all the essential nutrients, especially protein, in balance with proper quantity and quality of minerals and vitamins. Controlling your nutrition will be the most important tool on your road to wellness.

How We Can Help

If you suffer from IBD and arthritis, your treatment must be specifically individualized because too many factors are involved in each disease to take a simplistic approach. Comprehensive dietary plan, supplementation and physiotherapy are key . 

Dr. Koles has extensive experience in treating auto-immune diseases, particularly colitis and arthritis. As an immunologist, she has a deep understanding of the way our diet can cause our immune system to attack its own tissues. In treating IBD and arthritis, Dr. Koles uses various functional nutritional tests to assess your biochemical metabolic profile, food sensitivities and intestinal needs. 

She then devises a highly individualized treatment protocol that utilizes nutritional modification, supplementation with vitamins and minerals and special probiotics with the essential beneficial bacteria called E.Coli Nissle 1917, which has been proven to be as effective as standard anti-inflammatory medications for maintaining remission in ulcerative colitis patients without the associated side effects. It also effective treats many other intestinal problems, such as as Crohn's, intestinal dysbiosis, bacterial overgrowth and so on.

Dr. Koles is committed to helping both children and adults overcome both IBD and arthritis by treating its underlying causes.

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