Could my back pain be related to Crohn's disease?
Ask the doctor
Q. I am a 47-year-old female recently diagnosed with Crohn's disease. I do not appear to have a severe case; however, I have noticed more low back pain (I've had back problems in the past), along with pain sometimes going down my thigh that moves into my buttocks or pelvic area. Could this be related to the Crohn's?
A. Yes, it's quite possible that your back pain is related to Crohn's disease. That's because about 15% of people with Crohn's disease develop inflammation of the sacroiliac joint (sacroiliitis) or inflammation of other joints in the lower back.
The sacroiliac joint links the spine with the pelvis. When inflamed, symptoms include low back pain and stiffness that may spread into the buttocks and pelvis. Arthritis may also develop in other joints, such as a knee or ankle. When this happens, it's as if the inflammation present in the digestive tract - the hallmark of Crohn's disease - spills over into the joints. The same thing can happen with ulcerative colitis, another type of inflammatory bowel disease.
That said, back pain is remarkably common in people who do not have Crohn's disease. In fact, more than 80% of people see a doctor for back pain at some point in their lives. So, your back symptoms could be unrelated and coincidental. Other common causes include sciatica, muscle spasm, and disc disease.
It's usually possible to determine whether back pain is due to Crohn's-associated sacroiliitis or some other cause, and whether a treatment for Crohn's disease may also help the back pain.
The details of your symptoms, a physical examination, and, sometimes, imaging tests such as x-rays or MRI are typically useful to confirm or rule out sacroiliitis. For example, there are two distinguishing symptoms that suggest the presence of sacroiliitis: the pain improves when exercising, and the pain or stiffness tends to be much worse in the morning.
The severity of Crohn's disease does not always correlate with the presence or severity of arthritis. In fact, some people have arthritis first and only later develop colitis. Once sacroiliitis (or other arthritis) is present in a person with Crohn's disease, arthritis and colitis tend to get worse and better together; however, exceptions are common.
See your doctor about your back pain. If you do have Crohn's-related arthritis in the spine, the doctor may be able to recommend a single treatment that effectively treats both the colitis and the sacroiliitis.
Image: © Justin Paget/Getty Images
About the Author
Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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