June 15, 2024

1. Arthritis

Arthritis, or inflammation of the joints, is the most common complication of UC found outside the bowels. Various types of arthritis affect up to 30 percent of those with the disease, including both young and elderly patients, according to the Crohn’s & Colitis Foundation.

The severity of arthritis ranges from peripheral — mild joint pain and swelling with some loss of flexibility — to ankylosing spondylitis, a debilitating form of arthritis characterized by a dramatic loss of flexibility in the lower back, which affects about 3 percent of patients with IBD.

“While we can’t say there’s a direct cause, the joint pain usually flares up when the bowel disease flares up as well,” says Laura Raffals, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota.

Range-of-motion exercises can help prevent joints from flaring, and anti-inflammatory drugs can alleviate joint pain. Some medications, like sulfasalazine (Azulfidine), can help treat UC and arthritis.

2. Inflammation of the Skin, Eyes and Joints

As the name “inflammatory bowel disease” suggests, inflammation is one of the complications that can come with UC. But it is not limited to the bowel.

According to the Crohn’s & Colitis Foundation, up to 20 percent of people with an IBD have also experienced skin disorders, canker sores in the mouth, skin tags and pyoderma gangrenosum, or skin lesions, associated with UC.

A review published in March 2021 in the Journal of Clinical Medicine found that biologics effectively treated both UC and skin lesions.

“Biologics have shown to be highly effective treatments for a range of inflammatory diseases, and they’re much safer than steroids,” says Dr. Raffals.

Treatment for other skin disorders associated with IBD may include antibiotics, ointments, warm baths, and surgery.

Meanwhile, roughly 10 percent of IBD patients experience extraintestinal complications in their eyes, according to the Crohn’s & Colitis Foundation. The most common types — episcleritis and scleritis — piggyback with a UC flare. Uveitis, a type of inflammation in the pigmented part of the eye, is a complication of UC that follows its own course. Left untreated, it can progress to glaucoma and vision loss.

Eye drops with corticosteroids are generally prescribed to treat these complications, and effective management of UC will reduce the frequency and severity of inflammation in the eyes.

For bones, osteoporosis (bone loss) and osteopenia (low bone density) are common UC complications that can occur for a variety of reasons, including inflammation in the body that disrupts bone metabolism, medicinal side effects (particularly steroids), and vitamin D deficiency.

Bone loss is more common in people with Crohn’s disease, according to the Crohn’s & Colitis Foundation. Lifestyle measures, including regular weight-bearing exercise and supplements of calcium and vitamin D, may help prevent and treat this condition, as can prescription medication that boosts bone strength and density. Work with your doctor to customize your UC treatment plan to protect your bones; for example, lower doses of steroids might make sense for you.

3. Liver Disease

Nearly 3 percent of people with UC experience inflammation that causes scarring in the bile ducts (a condition called primary sclerosing cholangitis), according to the Crohn’s & Colitis Foundation.

“That’s the only liver disease associated with UC,” says Raffals. “Others, like fatty liver disease, may be attributed to steroid use, but there’s nothing about UC that causes them.”

There are no specific treatments for primary sclerosing cholangitis or fatty liver disease, though weight loss usually helps treat fatty liver disease.

4. Colorectal Cancer

The connection between UC and colorectal cancer is unknown, but a strong correlation occurs between the two, especially for people who have had UC for a long time.

“It seems mainly related to cellular changes caused by the autoimmune-mediated inflammation,” says Dr. Philpott. “Furthermore, if more of the colon is involved, then the risk is higher.”

But there is good news. A study published in Medicine in August 2020 suggested that the risk of colon cancer in UC patients has decreased over time, with a higher association being made with smoking. In either case, colon cancer is one of the most commonly diagnosed cancers for men and women in general, according to the American Cancer Society, and treatment looks similar to those with UC and includes surgery, chemotherapy, and radiation.

Still, Philpott says that people with UC should remain vigilant about screenings.

“We recommend that patients with UC who have a higher risk of colon cancer not wait for symptoms but rather undergo routine surveillance colonoscopies that look for precancerous changes,” says Philpott. “That being said, certainly, bleeding, weight loss, and change in bowel symptoms should always prompt you to consult your physician.”

5. Toxic Megacolon

In rare cases, people with UC can develop toxic megacolon, which is the swelling and inflammation of the deeper layers of the colon and can cause the colon to stop working or rupture.

According to an article published by StatPearls, toxic megacolon is most commonly associated with inflammatory bowel disease, especially ulcerative colitis, which has a rate four times higher than Crohn’s disease (8 percent versus 2.3 percent).

“Fortunately, this is a rare condition, but it’s very serious when it occurs,” says Raffals. “If a patient is severely ill from their colitis and is experiencing severe bloody diarrhea, abdominal pain, and fever, they should be evaluated. These patients often present with fever, a fast heart rate, abnormal labs, and even sometimes low blood pressure and confusion.”

UC patients should be given steroids as soon as possible, and bowel rest may be recommended. The main goal is to stabilize the patient and reduce inflammation in the colon. Raffals says that patients often end up requiring surgery, with the main complication being the perforation of the colon.

Ways to Reduce Complications

Early intervention and frequent surveillance of ailments are crucial to reducing complications and improving outcomes. Maintaining proper nutrition and avoiding emotional stress is essential, though neither stress nor sensitivity to certain foods causes the disease. Avoiding steroids can also be helpful if you and your doctor have an alternative way of treating UC flares.

While a simple cure for UC has yet to be found that doesn’t involve surgery, some complications may disappear altogether when the disease is appropriately treated. Work with your doctor and other healthcare team members to get optimal control of the disease as soon as possible.

Additional reporting by Zachary Smith.


Leave a Reply

Your email address will not be published. Required fields are marked *