What’s the Connection Between Crohn’s Disease and Arthritis?

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On April 7, 2025

The exact reason for enteropathic arthritis remains unclear, but it likely results from a combination or interaction of several factors.

Both Crohn’s — a type of inflammatory bowel disease (IBD) — and arthritis involve inflammation. Crohn’s may increase the risk of inflammation in other parts of your body through various mechanisms.

“Although primarily a disease of the gastrointestinal tract, Crohn’s can affect multiple organs,” says Jane Onken, MD, a professor of medicine specializing in gastroenterology at Duke University School of Medicine in Durham, North Carolina. Extraintestinal manifestations include oral ulcers, inflammatory conditions of the eye, certain skin lesions, and joint aches.

Arthritis that stems from Crohn’s can manifest as peripheral or axial arthritis, spondyloarthritis, ankylosing spondylitis, and symmetrical polyarthritis.

Genetic Predisposition

People with Crohn’s who develop arthritis often have changes in certain genes.

Those with spondyloarthritis and Crohn’s, for example, may have changes in the HLA-B27 gene, which relates to a protein on white blood cells. This protein can cause your immune system to attack healthy cells in your joints.

People with Crohn’s who have changes in the CARD9 gene may also develop inflammation elsewhere in the body because of reactions started by bacterial and fungal proteins in the gut.

Luminal Microbiota

The luminal microbiota is the community of bacteria and other microorganisms that live within the gut. A balanced gut microbiome helps you digest food and keeps the gut healthy.

Changes to the luminal microbiota may trigger immune reactions, leading to diseases such as Crohn’s and some types of arthritis.

Leaky Gut

The inflammation involved in Crohn’s can make the gut more permeable, or “leaky,” allowing bacteria and immune cells to more easily cross into the bloodstream and other parts of the body.

This could trigger an immune response elsewhere in the body, including the joints.

Immune System Dysfunction

Crohn’s and joint inflammation may result from an autoimmune disorder in which the immune system attacks healthy tissue in the gut and elsewhere. More studies are needed to explore this possibility.

Medication Use

Some Crohn’s medications can cause joint pain that’s not necessarily arthritis.

Drugs that have joint pain as a side effect include:

infliximab
azathioprine, in some people
steroids, when used for too long or stopped too quickly

Dr. Onken says that doctors often prescribe prednisone, a steroid, to treat both gut and arthritis symptoms in Crohn’s. “A potentially debilitating side effect of prolonged or frequent prednisone use is bone loss that can lead to osteoporosis, compression fractures of the spine, and more.”

For this reason, she says, “It’s important to try to minimize the use of prednisone whenever possible.”

People who use prednisone for a long time need close monitoring of bone density.

“Some Crohn’s patients are also at risk for bone loss due to vitamin D deficiency, so levels should be checked and replaced when necessary,” Onken says.