Orthopaedic experience on inflammatory bowel disease (Lesniowski-Crohn's disease and ulcerative colitis)

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the gastrointestinal tract. The major types of IBD are Lesniowski-Crohn's disease (L-CD) and ulcerative colitis (UC). Inflammatory bowel disease (IBD) sometimes presents with arthritic manifestations. The peripheral arthritis is a problem for the orthopaedist and the physiatrist.

The authors retrospectively reviewed 65 Sicilian patients with IBD (38 with UC, 27 with L-CD) over a period of 5 years. All patients underwent clinical examinations, laboratory and imaging studies, and were screened for the presence of the rheumatoid factor. All patients also attended eight to ten 50-minute sessions of physiotherapy over a six-week period.

38 patients had UC (mean age 42.1 years, range: 19 - 75) and 27 patients had L-CD (mean age 37.2 years, range: 17 - 64 years). Arthritis occurred in 11 patients (17%): 7 with UC (18.4%) and 4 with L-CD (14.8%). The mean age of patients with arthritis was 35 and mean duration of pain and functional limitation was 28 months. In 9 patients, arthritis appeared after the onset of bowel symptoms with a mean duration of 20 months in UC and 24 months in L-CD; in two patients, arthritis preceded the onset of bowel symptoms for several months. Exercise and manual therapy did not bring about good symptomatic improvement in patients with shoulder pain; good short-term results were only noted for patients with knee and hip arthritis.

The association between IBD and arthritis has been reported in the literature and confirmed in our study. The role of the orthopaedist is to eliminate pain and dysfunction. Physical therapy is an optimal initial approach. Prosthetic surgery should be chosen as a final option when medical and manual therapies are no longer able to improve the quality of life of the patient.