Rheumatic symptoms caused by a weakened gut

I’m quoting a text I came across; after naming the source, I’ll share my own comment and some further information on this topic.

In an estimated up to one third of all patients with chronic inflammatory bowel disease, so-called extraintestinal symptoms occur. This refers to complaints that appear outside the bowel. They can affect the skin, the joints or the eyes. Most commonly, it’s the joints. When inflammatory processes occur there — triggered by an overreaction of the immune system — this is referred to as arthritis. It can affect the limbs, the spinal joints, as well as the sacroiliac joints. It’s also possible, however, that it develops before the bowel disease becomes apparent.

A distinction is made between peripheral arthritis (affecting the limbs) and axial arthritis (affecting the spine). Peripheral arthritis is further divided into type 1 and type 2. Type 1 is an acute form that occurs in large joints such as the knee, hip, shoulder or elbow and usually affects fewer than five joints. It generally runs parallel to an inflammatory flare-up of the bowel disease and usually disappears again within less than ten weeks, without leaving permanent damage.

With type 2, five or more joints are almost always affected. Typically, it is the small joints — especially the wrists — which are involved, often in a symmetrical pattern.

These disease processes can extend over months or even years and are independent of the level of activity of the bowel disease. Other conditions that can occur alongside a bowel disease include
– Enthesiopathies: disorders affecting tendon attachment points near the joints
– Dactylitis: inflammation of the fingers or toes
– Arthralgias: joint pain without evidence of arthritis
– Secondary fibromyalgia syndrome
– Ultimately, burn-out symptoms or CFS (chronic fatigue syndrome)

To understand the specific condition properly, the medical history and physical examination are important — but blood tests and tissue analysis play a key role as well. Bowel diseases can be identified by examining tissue samples taken from the intestinal lining during an endoscopy. Inflammatory joint diseases can, in many cases, be detected through signs of inflammation in the blood. One relevant marker, for example, is HLA-B27. It can be found in around a quarter of patients with type 1 peripheral arthritis.

When treating arthritis, the underlying chronic inflammatory bowel disease has to be taken into account. This matters because certain arthritis medications can have the side effect of worsening the bowel condition. This can happen, for instance, with non-steroidal anti-inflammatory drugs (NSAIDs). If used at all, they should only be taken for short periods.

“Even though it has not yet been clearly established exactly how joint and bowel diseases are causally linked, research in recent years has identified a number of shared mechanisms involved in the development of inflammatory joint and bowel conditions. This opens up new perspectives for treating both clinical pictures together. Another step towards better therapeutic care could be the creation of interdisciplinary specialist clinics.”

This text was written by Klaus Bingler and published in the magazine “Orthopress”
www.orthopress.de

Why did I put that last section in quotation marks? Well… as an attentive reader, certain phrases jump out at me: “…research in recent years… has discovered a common link…”, “…new perspectives…”, “…better therapy… through interdisciplinary…”.

I know there are excellent orthopaedic specialists who understand these connections and actually ask the right questions. But in the end, this quoted passage almost pushes me to make the following sarcastic remark:

Aha. “In recent years” — so we’re talking the last six to eight years? So, around 2007 this insight finally filtered through into conventional medicine? Funny. Heilpraktiker were trained in holistic medicine more than 30 years ago, and for them this connection is nothing new. People even knew about it in the Middle Ages: if the gut isn’t in order, the person isn’t in order. It’s nice that these ideas are being taken on board in mainstream medicine. And also nice — in a way — that cautious wording with the word “could”… one could consider an interdisciplinary specialist clinic for better therapy… could… right. What exactly is “special” about that? And why could — why not should? And why does it take so long before it’s actually done? That’s where my sarcasm ends — and I’d like to continue with the clinical picture.

Important for physiotherapists who often treat disorders at tendon attachment points near joints:
Ask about irritable bowel syndrome and food intolerances. Axial joint inflammation can stem from enteropathic spondylitis. (Ask about ankylosing spondylitis, Crohn’s disease, ulcerative colitis…). Osteopathy can make a real difference here.

I’ve met quite a few people who are overweight — even obese — who have been to a Heilpraktiker. And they don’t go back, because the “nasty” Heilpraktiker said: lose weight! no pork! less or no coffee! less or no alcohol! much less sugar! more movement! maybe even a fasting diet! And they won’t return — how dare the Heilpraktiker ask that of them? Taking away the German’s food… the one thing they still have in life that’s fun…

The causes of bowel disorders:
– Predisposition. Research has found that even the composition of our gut flora can be genetically anchored. That doesn’t mean, however, that we are powerless in the face of genetics.
– Pathogens. In domestic water supplies, for example, there may be Legionella; and there may also be pathogens such as Yersinia enterocolitica, which can be found, for instance, in inadequately cooked pork. Many (raw) sausage products also contain phosphates, glutamates and curing salts.
– Migrants and immigrants may come from regions where meat preparation is not subject to the same controls as it is here. That means parasites such as Trichinella — which can lodge in muscle tissue (and are very difficult, if not impossible, to eliminate) — can cause (and will cause!) a great deal of trouble.
– Food intolerances: lactose is relatively easy to manage; gluten (coeliac disease) is more challenging; and fructose can be more difficult still. The problem is that many people don’t even realise they can’t tolerate something — and even fewer know how to deal with it consistently.
– Enzyme deficiency. This may be predispositional. A stool sample can provide clarity, and replacement is possible.
– Constant irritation from toxins and stimulants
– Chronic stress
– The wrong foods — and too much food.

Error :
-Treating symptoms with painkillers without addressing — or even limiting — the underlying causes.
-Then trying to compensate long-term for the side effects of those painkillers with proton pump inhibitors (pantoprazole and similar) — again and again, and often indefinitely.
-Cigarettes, coffee, alcohol and stress are not reduced in any meaningful way.
-Even “healthy” foods are often contaminated (glyphosate and much more). And “more is better” doesn’t apply here. Calories and movement still matter. People who are overweight, eat a lot of healthy food (too much food), and don’t move enough will still gain weight — despite all their good intentions. The gut is always working, always full. Fasting is tough, but it can be worthwhile.

From this, it becomes fairly clear what might help: eating less, cutting down markedly on stimulants and “treats”, changing what you eat, less sugar, a more alkaline diet — tailored to any food intolerances (which may even mean avoiding “healthy” fruit if fructose is an issue). Add to that rebuilding the gut (cultures, guiding the microbiome, bitter herbs…). And then: movement, movement, movement. It’s the hard road — but often the one that works.

A road that many people simply don’t want to take (or can’t).