Overall Symptoms of a Crohn’s Flare
There are general symptoms that “potentially indicate active Crohn’s disease,” says Joseph Feuerstein, MD, an attending gastroenterologist at the Center for Inflammatory Bowel Disease at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School, in Boston. These include:
Abdominal pain (i.e., stomach pain)Loss of appetiteNauseaVomitingFeverWeakness or fatigueNight sweatsWeight loss
People with Crohn’s will often experience a few of these symptoms at the same time. “It would be unusual, though, for any one of these symptoms on its own to be a sign of a Crohn’s flare,” says Dr. Feuerstein. If you experience a loss of appetite and abdominal pain with nausea or vomiting, for example, it could be a sign of strictures, Feuerstein says, which are narrow passageways caused by thickening or scarring of the bowel walls. Fevers, night sweats, and weight loss may indicate the presence of fistulas, which are connections from the bowel into other tissues or organs. “In cases where the GI tract has not opened [outside the bowel], patients can develop an abscess,” he says. The following are the most common EIMs.
Arthritis
Inflammation of the joints is the most common EIM, affecting up to 30 percent of people with Crohn’s, according to the Crohn’s and Colitis Foundation of America. “Arthritis can affect the joints or the axial skeleton [the bones of the head and trunk],” Feuerstein explains. Different types of arthritis may flare up along with disease activity or manifest as a more chronic condition that starts with a flare but then lingers. When arthritis develops with active disease, it typically gets better as intestinal symptoms improve. Chronic arthritis is more difficult to treat, says Feuerstein. “For immediate symptomatic relief, we always first recommend trying acetaminophen,” he says. (People with IBD should avoid nonsteroidal anti-inflammatory drugs, or NSAIDs.) Biologic medications may be recommended for severe joint pain.
Skin changes
Skin conditions can also be a complication of Crohn’s. Erythema nodosum is an EIM that causes raised, tender red and violet lumps that usually appear on the shins. Pyoderma gangrenosum starts as a small pustule and evolves into a large ulcer with irregular borders and a purplish edge, most often on the legs. “These ulcers are more common with Crohn’s disease,” says Feuerstein, “but they can occur with ulcerative colitis as well.”
Liver problems
A common and fairly minor complication of Crohn’s is fatty liver disease, which doesn’t usually cause symptoms or require treatment. A more serious liver complication is primary sclerosing cholangitis, which causes severe inflammation, scarring, and narrowing of the bile ducts. “While this is more common among people with ulcerative colitis, it can develop with Crohn’s disease as well,” says Feuerstein. “Typically, it’s a progressive EIM and may develop into cirrhosis and cholangiocarcinoma [cancer of the bile ducts].” Also, the risk for gallstones is higher in those with Crohn’s disease compared with people without the condition, according to a study published in September 2015 in the Journal of Digestive Diseases. To avoid this complication, try eating a low-fat diet.
Eye disorders
Most of the eye complications associated with IBD are both treatable and unlikely to cause vision loss, according to the Crohn’s and Colitis Foundation of America. Episcleritis, a condition that causes redness on the white of the eye, often goes away when Crohn’s symptoms begin to improve with treatment. Uveitis causes pain in the middle layer of the eye — as well as blurred vision, light sensitivity, and headaches — and may come on gradually or suddenly. “Early recognition and treatment of uveitis is important,” says Feuerstein. If left untreated, the condition can become a medical emergency that may cause loss of vision.
Mouth sores
Oral ulcers (canker sores) are most likely to occur during a flare and tend to subside when Crohn’s is under control. “For symptomatic relief, patients often use a lidocaine-based mouthwash,” says Feuerstein. “The lidocaine provides some numbing to alleviate the pain.”
Kidney stones
These occur most often in Crohn’s patients with small bowel disease and those who’ve had multiple small-bowel resections, explains Feuerstein. Kidney stones usually cause sharp pain in the sides as well as nausea and vomiting. They can be prevented by eating a low-fat and low-oxalate diet. (Oxalate is a chemical found in plant foods, particularly spinach, bran, nuts, and potato chips and French fries.) Feuerstein adds that it’s important to drink lots of fluids, especially ones that contain electrolytes. Treatments for kidney stones vary, depending on the severity of symptoms. Some people may need to consult a nephrologist or urologist.
