Having psoriatic arthritis (PsA) can increase the chance of developing other health conditions. Having more than one health condition is known as a co-morbidity. One of the co-morbidities that people with PsA may develop is inflammatory bowel disease (IBD).
What is inflammatory bowel disease
Inflammatory bowel disease, or IBD, is the term used to describe a group of conditions that involve inflammation of the gastrointestinal tract. The most common types of IBD are Crohn’s disease and ulcerative colitis.
What are the symptoms?
The symptoms of IBD may include:
- Abdominal pain and/or cramping
- Bloody stools
- Low appetite
- Unintended weight loss
What causes IBD in people with PsA?
PsA is what is known as an auto-immune disease. This means that the immune system becomes overactive and starts to attack healthy tissue, causing inflammation. In people with PsA this inflammation can occur in different systems in the body, including the gastrointestinal tract. Because of this people with PsA have a higher risk of developing IBD compared to the rest of the population.
How is IBD diagnosed?
If your doctor suspects you may have IBD, they will likely refer you to a gastroenterologist. A gastroenterologist is a medical doctor who specialises in diseases of the gastrointestinal tract.
The doctor will ask about your medical history and perform a physical examination. They may also do some other tests, including blood tests, stool tests, scans and a gastroscopy and colonoscopy. These tests will help to determine if you have IBD.
What will happen to me?
As with PsA, your IBD symptoms can disappear and reappear over time. You will likely experience periods where your symptoms decrease or are inactive. This is known as being in ‘remission’. Periods where your symptoms are active are known as having a ‘flare’.
Once IBD has been diagnosed, the condition can usually be managed. Most people with IBD lead full and productive lives. However, if it is not well-managed complications can occur and require medical attention. Seeing your doctor regularly and letting them know when flares occur can help to manage the condition.
Can IBD be cured?
Unfortunately, IBD cannot be cured. However, with the right treatment, symptoms of IBD can be effectively managed. When the disease is kept in remission, the impact of the disease and the likelihood of flares will be kept to a minimum.
What treatments are there for IBD?
Often treatments for IBD are like those recommended for PsA. Depending on whether your IBD is in remission or whether you are experiencing a flare you may find your doctor suggests one, or a combination, of the following:
- Corticosteroids. These will likely be used only for short periods to manage flares
- Immunomodulators. These medicines help to regulate the immune system and reduce inflammation. They may be used for longer periods.
- Biologic disease modifying anti-rheumatic drugs, often known as ‘biologics’ or ‘bDMARDs’. This type of medication targets specific proteins in the body that cause inflammation. A number of different biologics are available and different ones work better for some people than others. Some of these biologics are effective in treating both IBD and PsA. Where possible, your gastroenterologist and rheumatologist should work together to find a bDMARD that will help both your IBD and your PsA.
Non-steroidal anti-inflammatory drugs (NSAIDs) can help to reduce inflammation but can also make IBD symptoms worse. They are often not recommended for people with PsA who experience IBD symptoms.
It may take some time to figure out the best treatment plan for you. Work with your doctor to figure out what works best for you in managing your PsA and your IBD.
What can I do?
Aside from trying to ensure your PsA is well-managed and seeing your doctor regularly, there is a lot you can do to help limit the impacts of IBD.
- Some foods are more likely to aggravate IBD symptoms, such as fatty, greasy foods or sugary foods and drinks, but everyone’s experience of IBD is different. There is little evidence that following a certain diet can help either your IBD or PsA. Instead, it is important to find out which foods help you and which ones make your IBD symptoms worse. Keeping a food diary that tracks your symptoms may help you to figure out what works for you.
- You can lose nutrients when you have IBD, so it is important when figuring out what foods work for you to consider how to replace those lost nutrients. For example, if you find that eating raw vegetables makes your symptoms worse, try cooking them thoroughly so that you still get the nutritional benefits while minimising the impact on your IBD symptoms.
- It is important to see a dietitian. These health professionals specialise in the impacts of diet on health and can help you figure out the balance between managing IBD symptoms and ensuring you get the nutrients you need to stay healthy.
- Consider taking a multi-vitamin or a mineral supplement. You should always talk to your doctor or dietitian about whether you should take supplements.
- Quit smoking. Smoking can make the symptoms of IBD worse and more difficult to treat. Speak with you doctor about ways that can help you quit or call the Quitline on 13 78 48.
- Speak to your doctor about ways to relieve discomfort from the symptoms of IBD, particularly if you are experiencing a flare.
- Speak with your doctor about seeing a counsellor or psychologist if you feel you need to talk to someone about the impact IBD or PsA is having on your mental wellbeing.
- Make sure you are looking to reliable sources for information on IBD and PsA. A large amount of information is available online but not all of it is from reliable sources or based on scientific evidence. Always speak with your doctor If you are unsure about the accuracy of any information.
For further information on IBD or to access support services see Crohn’s & Colitis Australia https://www.crohnsandcolitis.com.au/
This resources has been developed based on the best available evidence. A full list of references is available upon request.