Inflammatory Bowel Disease: Improving Quality of Life | Q&A
Inflammatory Bowel Disease and Ankylosing Spondylitis
People with ankylosing spondylitis sometimes develop a gastrointestinal condition, too. Find out what connects inflammatory bowel disease and ankylosing spondylitis and how you can treated them in tandem.
By Regina Boyle Wheeler
Medically Reviewed by Farrokh Sohrabi, MD
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Living with the back pain of ankylosing spondylitis is hard enough. Imagine having to deal with another chronic condition on top of it, one that causes inflammation and irritation in the bowels and triggers abdominal pain, diarrhea, and other intestinal problems. For many, that's a daily reality.
“Somewhere around 5 to 10 percent of individuals with AS also have inflammatory bowel disease (IBD), either Crohn's disease or ulcerative colitis,” said Joel Taurog, MD, professor of internal medicine and immunology in the division of rheumatic diseases at the University of Texas Southwestern Medical Center in Dallas.
Donna Laymon, a 73-year-old retired lab technician from northern California is part of that group. On top of having AS (which went undiagnosed for 50 years), Laymon was diagnosed with ulcerative colitis in 1997. “The first big flare was severe. It took 9 months of prednisone [a corticosteroid] to get it under control. My symptoms were diarrhea and abdominal cramps. I was lucky in that I rarely had any problems with bleeding, a symptom that affects many people with ulcerative colitis," she said. Another anti-inflammatory medication has since put the colitis in remission.
Laymon said having a flare-up of her inflammatory bowel disease and ankylosing spondylitis at the same time was very hard to handle and is grateful it didn’t happen often.
IBD and Ankylosing Spondylitis: What’s the Link?
An abnormal immune response in the digestive tract appears to play a role in both Crohn’s disease and ulcerative colitis. The immune system is made up of proteins and cells that normally protect against infection. In IBD, the immune system mistakenly attacks harmless or even beneficial cells as if they are harmful invaders. This immune response is believed to cause the chronic inflammation seen in IBD that damages the gastrointestinal tract and causes symptoms.
Why do some people with ankylosing spondylitis develop inflammatory bowel disease? “The association is largely genetic,” said Dr. Taurog. “Over half of the 30-plus genes that have been identified as susceptibility genes for AS are also susceptibility genes for IBD.”
Looking back, Laymon said both inflammatory bowel disease and ankylosing spondylitis run in her family. “My grandmother had both — at least we think she did. She called it spastic colitis, and her arthritis was much worse than mine. They didn’t have much to treat with back then.”
Treating IBD and Ankylosing Spondylitis
“In full-blown AS, some of the anti-TNF therapies that have currently been approved for Crohn’s disease and ulcerative colitis can be used to treat ankylosing spondylitis,” said Ashwin Ananthakrishnan, MBBS, MPH, a gastroenterologist at Massachusetts General Hospital in Boston and an assistant professor of medicine at Harvard Medical School. These drugs help both conditions by targeting the inflammation-causing substance called tumor necrosis factor or TNF, which is produced by the immune system.
Infliximab (Remicade), adalimumab (Humira), and golimumab (Simponi) are approved as both AS treatment and IBD therapy, Dr. Ananthakrishnan said. He added that the dosing can be different in people dealing with both conditions, so a conversation between your rheumatologist and gastroenterologist is needed.
For pain relief, many people with AS rely on non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and others. But when Crohn’s or ulcerative colitis is part of the mix, doctors are very cautious about using NSAIDs because they can cause a flare of the bowel disease. Ananthakrishnan said that taking them once in a great while is probably safe, but long-term or high-dose use of NSAIDs could cause a problem. Getting effective therapy for both AS and IBD can reduce the need for these kinds of pain medication, he added.
Laymon's AS causes fatigue and pain in her shoulders, elbows, wrists, hands, and knees, but taking an anti-TNF drug seems to be helping.
If you are experiencing symptoms of IBD, don’t wait to talk to your rheumatologist. Your rheumatologist can help you find a reliable gastroenterologist to help better manage your symptoms.
Video: Chronic Inflammation in IBD and How Anti-TNF Therapy Works
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