Insights from Dr. Sherry Rohekar, Rheumatologist
Enteropathic arthritis (EnA) is a form of inflammatory arthritis that occurs in people living with inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis. It’s one of several types of spondyloarthritis, a group of autoimmune diseases that can affect the spine, joints, and other parts of the body.
To help people better understand and manage this condition, the Canadian Spondyloarthritis Association (CSA) hosted a discussion with Dr. Sherry Rohekar, a rheumatologist and researcher based in London, ON, who specializes in spondyloarthritis and related inflammatory conditions.
Below are key highlights from the session, Managing Flares and Symptoms for Enteropathic Arthritis.
What Is Enteropathic Arthritis?
“Enteropathic arthritis is a type of inflammatory arthritis that’s related to Crohn’s disease and ulcerative colitis,” explains Dr. Rohekar. “Essentially, the same immune response that mistakenly attacks the lining of the bowel can also target the lining of the joints.”
This inflammation can affect small joints in the hands, larger joints like the knees and ankles, and sometimes the spine and sacroiliac joints. Because the immune system’s response isn’t limited to one part of the body, many people with IBD may experience joint pain or stiffness at some point in their lives.
Recognizing Early Signs of a Flare
Flares can occur even after periods of stability. According to Dr. Rohekar, early warning signs may include:
- Increased pain and stiffness
- Fatigue
- Swelling in the joints, particularly the knees, ankles, or hands
- Trouble gripping objects or moving easily in the morning
If these symptoms last more than a few days or start worsening, it’s important to reach out to your rheumatologist. “If symptoms persist for several weeks, you may not just be having a flare, your disease may no longer be well controlled,” she cautions.
Pain Relief and Flare Management
There are several strategies that can help relieve pain and stiffness during a flare:
- Exercise and physiotherapy: Gentle movement and stretching are key, especially for spinal involvement.
- Topical treatments: Products like diclofenac (Voltaren) gel may ease localized inflammation.
- Heat or ice: Try both to see which provides better relief.
- Compression: Support sleeves or wraps can help reduce swelling.
- Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) may help but must be used cautiously in people with IBD. If one or two joints are particularly swollen, a corticosteroid injection may provide fast relief.
Physical Activity During a Flare
Movement remains an essential part of managing EnA, but it’s important to listen to your body.
“It’s safe to stay active during a flare, but don’t push yourself too far,” says Dr. Rohekar.
“Your brain may want to do more than your body is ready for.”
Gentle, low-impact activities are best. Working with a physiotherapist familiar with spondyloarthritis can help tailor exercises to your needs. Aquatic exercises can be particularly beneficial, as the water’s buoyancy reduces pressure on painful joints.
CSA also offers free exercise resources to support safe movement for people with spondyloarthritis.
The Role of Diet
While research on diet and EnA is limited, Dr. Rohekar suggests focusing on a balanced, Mediterranean-style diet rich in omega-3 fatty acids, leafy greens, fruits, and vegetables.
Some people experiment with elimination diets to identify personal triggers, but she advises doing so gradually and safely:
“Don’t remove everything all at once, eliminate one thing at a time and make sure your diet still provides adequate nutrition.”
Understanding Medication Adjustments
For short-term flares, medications usually remain unchanged. However, prolonged symptoms may indicate the need for an adjustment.
“In those cases, we may consider modifying the disease-modifying drugs or biologics to regain control,” Dr. Rohekar explains.
Common Triggers for Flares
Flares can be unpredictable, but some common triggers include:
- Stress: Emotional or psychological stress is a major contributor. “When life gets stressful, remember to pace yourself,” she says. “You can’t help others if you’re not taking care of yourself.”
- Overexertion: Overdoing physical activity or travel can also trigger symptoms. Try to plan ahead, take breaks, and build rest into your schedule
Lifestyle Modifications to Reduce Flare Frequency
Dr. Rohekar recommends several long-term strategies for maintaining better disease control:
- Quit smoking: Smoking worsens inflammation and accelerates joint damage.
- Stay active: Regular physiotherapy and stretching improve mobility and reduce stiffness.
- Maintain a healthy weight: This can reduce pressure on joints and improve overall health.
- Prioritize self-care: “Many people with arthritis feel guilty for slowing down,” says Dr. Rohekar. “But taking care of yourself means you can continue to be there for others.”
Final Thoughts
Living with enteropathic arthritis can be challenging, but understanding your body, recognizing early signs of a flare, and maintaining consistent care can make a meaningful difference.
“Remember,” says Dr. Rohekar, “you’re not alone, and with the right support, treatment, and lifestyle adjustments, you can take control of your health and live well with this condition.”