Crohn's Disease and Back Pain

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Question:

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?

Answer:

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 sacroiliitis (an inflammation of the sacroiliac joint) 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 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. The details of your symptoms, a physical examination and, sometimes, imaging tests such as X-rays, CT scan 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 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.