Managing Enteropathic Arthritis (EnA): Tips for Taking Control of Your Health

• Medication Management: Treating Both Gut and Joint Inflammation 
• Nutritional and Dietary Considerations
• Exercise and Physical Therapy: Keeping Joints Flexible
• Managing Stress and Mental Health
• Building a Strong Healthcare Team
• Tracking Symptoms and Flares 
• Additional Resources for people with EnA

Here’s a look at the key approaches to managing EnA, from medical treatments to lifestyle changes.

1. Medication Management: Treating Both Gut and Joint Inflammation 

Medication is often the first line of defense in managing EnA symptoms. A treatment plan typically targets both joint inflammation and the underlying bowel condition. 

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are commonly used to reduce joint pain and swelling, though some patients with IBD may need to use them cautiously, as they can exacerbate digestive symptoms. 
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Medications like methotrexate or sulfasalazine may be prescribed to manage inflammation in the joints. They work by suppressing the immune system’s response, which helps reduce flare-ups.  Sometimes, DMARDs may also improve bowel symptoms. 
• Biologics and Targeted Therapies: Biologics are a class of medication that target specific immune pathways involved in inflammation. Medications like TNF inhibitors (e.g., adalimumab, infliximab), IL-23/IL-12 inhibitors, or JAK  inhibitors are particularly effective for both IBD and EnA, providing relief for joint pain while also reducing bowel inflammation. 
• Steroids: Corticosteroids may be used during flare-ups for quick symptom relief. However, they are generally used short-term to avoid long-term side effects. 

Working closely with a rheumatologist and gastroenterologist can help tailor your treatment plan, adjusting medications to address both joint and digestive symptoms effectively. 

2. Nutritional and Dietary Considerations 

Nutrition plays a pivotal role in managing IBD, which in turn influences EnA. Although no universal diet works for everyone with EnA, some dietary changes may help reduce inflammation and improve symptoms. 

• Consulting a Dietitian: A registered dietitian who specializes in IBD can help create a personalized eating plan that supports your digestive and joint health. They can guide you regarding foods that may ease symptoms and ensure you’re meeting all your nutritional needs.
• Anti-inflammatory Foods: Foods like leafy greens, berries, fatty fish, and nuts can help combat inflammation. These nutrient-dense foods support overall health and may help mitigate symptoms over time. 
• Avoiding Trigger Foods: Foods that commonly aggravate IBD, such as spicy or fried foods, caffeine, and dairy, may also worsen joint symptoms. Identifying your specific triggers through a food diary can be helpful.

3. Exercise and Physical Therapy: Keeping Joints Flexible 

Regular exercise and physical therapy can be transformative for people with EnA. Movement helps reduce joint stiffness, strengthen muscles, and improve range of motion, all of which are essential for managing arthritis.

• Low-Impact Exercises: Activities like swimming, cycling, and walking provide cardiovascular benefits without putting too much strain on your joints. Yoga and tai chi can also improve flexibility, balance, and muscle strength.
• Stretching and Range of Motion Exercises: Stretching can alleviate stiffness and increase joint flexibility. Working with a physical therapist can help ensure you’re using safe and effective stretches tailored to your needs.
• Strength Training: Strengthening the muscles around your joints provides additional support, reducing stress on the joints themselves. 

Creating a consistent exercise routine, ideally with guidance from a physical therapist, can help maintain mobility, reduce pain, and boost energy levels. 

4. Managing Stress and Mental Health 

Living with a chronic condition that affects both your joints and digestive system can be mentally and emotionally taxing. Stress can exacerbate both arthritis and IBD symptoms, creating a cycle that impacts your overall well-being. 

• Mindfulness and Relaxation Techniques: Practicing mindfulness, meditation, and breathing exercises can help reduce stress, which may, in turn, reduce symptoms. Apps, classes, or even short daily routines can make mindfulness accessible and beneficial.
• Therapy and Support Groups: Speaking with a mental health professional or joining a support group for people with arthritis or IBD can provide emotional relief, a sense of community, and coping strategies for managing stress and anxiety. 
• Lifestyle Adjustments: Building a routine that allows time for rest, self-care, and enjoyable activities can make a big difference. Finding what works for you—whether it’s a hobby, time in nature, or connecting with friends—helps create a balanced life around your condition. 

5. Building a Strong Healthcare Team 

Given the dual nature of EnA, it’s essential to work with a healthcare team that includes both a rheumatologist and a gastroenterologist. Regular appointments, open communication, and a clear treatment plan can empower you to manage your symptoms effectively. Consider also consulting with a nutritionist, physical therapist, or mental health professional to address different aspects of your health. 

6. Tracking Symptoms and Flares 

Keeping a record of your symptoms, diet, and any factors that might contribute to flares can be an invaluable tool for both you and your healthcare team. Using a journal, such as the one available from the CSA, can help identify patterns, recognize triggers, and inform treatment adjustments. The Pain Management and Wellness Journal is a tool approved by medical professionals and designed by patients to help you understand your pain patterns, triggers, and develop effective pain management strategies.  

Anyone can access a free digital download (click here) of the journal to print at home. If you prefer to receive a printed version with three months’ worth of daily fillable pages, they are available for purchase on Amazon (click here) via the links below with 100% of proceeds going to the CSA for creating more resources and tools. 

A Final Word: There is Hope and Support 

As a rheumatologist, I see firsthand that managing EnA is a journey filled with both progress and setbacks. Having a supportive healthcare team and access to resources can make a world of difference, and the Canadian Spondyloarthritis Association (CSA) is here to offer additional support, information, and a community that understands the unique challenges of EnA. 

However, I know that not everyone has easy or equitable access to the resources they need. Many of my patients face obstacles such as living in remote areas, lacking reliable transportation, enduring long waitlists, or navigating language barriers. We will continue to work towards addressing these challenges and expand support, making resources more accessible to everyone. It is also recognized that the need for greater awareness and more specialized resources for EnA is essential, and we are committed to developing these over the coming months. 

Ultimately, while effective disease management and lifestyle adjustments play important roles, self-empowerment is key. With the right information, support, and community around you. Remember, you are not alone—help is here to guide you every step of the way toward well-being. 

CSA Resources