Colon cancer is the third most common cancer diagnosed among men and women in the United States annually. Cancer may begin as a noncancerous accumulation of cells called polyps inside the colon but over time these polyps can become malignant.
WHO IS AT RISK?
- Increase in age
- African American race
- Personal history of polyps or colorectal cancer
- Family history
- Eating a low fiber and high-fat diet
- Inactive lifestyle
- Hx of radiation therapy to the pelvis and abdomen
- SMOKING and heavy ALCOHOL intake
WHAT IS THE CONNECTION TO ARTHRITIS?
Inflammatory bowel disease such as Ulcerative Colitis (UC) and Crohn’s disease (CD) have rheumatic manifestations.
I see many patients who present with joint pain and inflammation associated with Inflammatory Bowel Disease which may cause symptoms of abdominal pain and cramping, bloody diarrhea and fever.
Arthritis associated with Inflammatory bowel disease is belongs to a group of arthritis called Spondyloarthropathies.
The risk for colon cancer is equal for UC and CD and the rate increases after having 8-10 years of colitis. These diseases cause chronic inflammation of the intestinal tract and can eventually lead to abnormal cells in the large intestine as well as joint inflammation causing enteropathic arthritis.
Here are some features of Enteropathic Arthritis:
- The male to female ratio is equal
- Arthritis can occur in the spine and bilateral sacroiliac joints
- There can be one or a few peripheral joints involved (oligoarticular arthritis)
- Uveitis or eye inflammation may occur rarely
- “Sausage digits” or dactylitis is uncommon unlike in psoriatic arthritis
- There may be skin findings (erythema nodosum and pyoderma gangrenosum) that is seen with IBD
- HLA B27 gene may be present
There is a connection between the gut and joint inflammation. This type of arthritis occurs in approximately 20% of individuals with IBD. Usually a few, large joints and can be involved such as the knee and the low spine and sacroiliac joints are often affected. Joint pain and swelling in the ankles, wrists, elbows can also be seen. It is asymmetric unlike rheumatoid arthritis that tends to affect the small joints like the hands and wrists and will occur on both sides equally.
It is important to treat your ulcerative colitis to reduce the chance of joint manifestations. Often the spine involvement may not improve much even with better control of IBD.
Treatment for IBD associated arthritis include:
- Nonsteroidal Anti-inflammatory drugs (Naproxen, Advil) – Be careful because colitis may worsen.
- Disease-Modifying agents (sulfasalazine, Azathioprine)
- Biologic injections
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Golimumab (Simponi)
- Infliximab (Remicade)
In my arthritis patients with IBD, I make sure they are ALL seen by a gastroenterologist to assess their colon cancer risk and have early cancer screening with a colonoscopy.