Not all Crohn’s disease symptoms involve the gastrointestinal tract. Here are other signs of a disease flare.
Crohn’s disease can cause eye problems such as uveitis, a type of eye inflammation. If you have Crohn’s disease, you probably know the gastrointestinal (GI) signs of a flare all too well. But there are other, more surprising signs that your disease is waking up, including symptoms that can affect your mouth, joints, and general well-being.
General symptoms of a Crohn’s flare
There are general symptoms that may indicate active Crohn’s disease. These symptoms are as follows
bowel obstruction accompanied by nausea, vomiting, absence of gas and bloating.
It is possible and common for people with Crohn’s disease to experience multiple symptoms at the same time. However, it would be unusual for just one of these symptoms to be a sign of a Crohn’s attack. If you start experiencing multiple symptoms, it may be time to see a doctor. If you suffer from loss of appetite and abdominal pain accompanied by nausea or vomiting, for example, this could be a sign of strictures, which are narrow passages caused by thickening or scarring of the intestinal walls. A fistula, which is an abnormal connection or passage from the bowel to other tissues or organs, can lead to changes in bowel habits. If these symptoms are accompanied by fever, night sweats, and weight loss, it usually means the fistula is infected.
Non-invasive signs of a Crohn’s disease flare
Up to 40% of people with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, have extra-intestinal manifestations (IED): symptoms that occur outside the gastrointestinal system. The causes of IBD are unclear, but research suggests a genetic predisposition.
Whatever the reason, a study published in the August 2021 issue of Gastroenterology finds IBD to be a significant additional burden for people with IBD. They can occur with variable frequency depending on the organ affected, before or after the diagnosis of IBD. For people with Crohn’s disease, the study found that the musculoskeletal system, skin, hepatobiliary tract and eyes were most likely to be affected.
Here are some common MEIs
Joint inflammation is the most common IBD, affecting up to 30% of people with Crohn’s disease. Arthritis can affect the joints or the axial skeleton (the bones of the head and trunk). Different types of arthritis can manifest as flare-ups concurrent with disease activity or manifest as a more chronic condition that begins with a flare-up but then persists.
When arthritis develops concurrently with active disease, it usually improves as bowel symptoms subside. Chronic arthritis is more difficult to treat. People with IBD should avoid nonsteroidal anti-inflammatory drugs, or NSAIDs. Other medications may be recommended for severe joint pain.
Skin conditions can also be a complication of Crohn’s disease. Erythema nodosum is an IBD that causes red and purple, tender, raised bumps, usually appearing on the shins and may affect up to 10% of people with IBD. Pyoderma gangrenosum begins as a small pustule and progresses to a large ulcer with jagged edges and a purplish edge, most often on the legs. These ulcers are more common with Crohn’s disease but they can also occur with ulcerative colitis.
A common and relatively minor complication of Crohn’s disease is fatty liver disease, which usually causes no symptoms and does not require treatment. A more serious liver complication is primary sclerosing cholangitis, which results in severe inflammation, scarring, and narrowing of the bile ducts. Although this disease is more common in people with ulcerative colitis, it can also develop in the case of Crohn’s disease. Usually it is a progressive IBD that can progress to cirrhosis and cholangiocarcinoma (cancer of the bile ducts). Separately, the risk of gallstones is higher in people with Crohn’s disease than in those without, according to a systematic review published in the June 2022 issue of Cureus.
Most ocular complications associated with IBD are both treatable and unlikely to cause vision loss. Episcleritis, a condition that causes redness on the white of the eye, often goes away when symptoms of Crohn’s disease begin to improve with treatment. Uveitis causes pain in the middle layer of the eye, as well as blurred vision, sensitivity to light, and headaches, and can come on gradually or suddenly. Early recognition and treatment of uveitis is important. If left untreated, this condition can become a medical emergency and lead to vision loss.
Mouth ulcers (canker sores) are more likely to occur during a flare-up and tend to go away when Crohn’s disease is under control. To relieve symptoms, patients often use a specific-based mouthwash that provides some numbness that dulls the pain.
These stones occur most often in patients with Crohn’s disease who have small bowel disease and those who have had multiple small bowel resections. Kidney stones usually cause sharp pain in the sides as well as nausea and vomiting. They can be prevented by adopting a diet low in fat and oxalate. Oxalate is a chemical found in plant foods, especially spinach, bran, and nuts. It is important to drink plenty of fluids, especially those that contain electrolytes. Treatments for kidney stones vary depending on the severity of the symptoms. Some people may need to see a nephrologist or urologist.