SEVERE Arthritis? after Diverticulitis & bowel resection
33yo son diagnosed with severe diverticulitis July 09. After 3 days in hospital with no food or water, only IV he developed SEVERE swelling in one ankle & heel & swelling in one finger. Both extremely painful. At first they thought this might be a reaction to the antibiotics . They sent him home. After 4 days at home he could not walk,, heel was black and blue and he was in extreme pain. I took him to family DR.. thought it might be gout, put him on Prednisone 20mg 3x daily and Indomethacian. 50mg 2x daily. meds seemed to work for abit... A few weeks later the diverticulitis flared up again, saw surgeon, needed sugery sooner. The night before he had no food/water. When he got up morning of surgery.. both knees very swollen/painful and he could hardly walk! He had bowel resection surgery on 8/7/2009. intestines were healing fine, but joints were going from bad to worse. He had severe pain & swelling in both knees, both ankles and one wrist. After 1 week they sent him home. Saw a Rheumatology specialist 10 days post op, She took needle aspiration and ruled OUT gout.. they did lots of blood work.. have come up with nothing.
Last week once again he was almost unable to move.. went back to specialist.. who now put him on (6) 2.5mg of Methotrexate once a week and 1mg of Folic Acid daily in addition to the other 2 meds he's on. When reading the warning of the Methotrexate I became concerned, especially since no one really seems to have any idea what is his problem. Prior to being in the hospital the 1st time.. he NEVER had any joint issues.. was a fairly healthy 33yo male, not overweight.. does smoke and drink, but never really had any health issues. Having such severe diverticulits at such a young age is somewhat rare, and 3 weeks post op, those issues are doing pretty well, but the severe joint pain is getting very frustrating to him..Where do we go from here?? Who can we see??
This is a very rare combination of diverticulitis of the sigmoid colon and arthritis. There is no name of this disease or reason for why it occurs. Very few cases have been reported and documented in medical history. As he has already been cured of diverticulitis by surgery and all his parameters tested near a Rheumatologist are negative clearly suggest he does not have any auto immune disease.
You should see an Orthopedician or Rheumatologist and continue his symptomatic arthritis treatment and follow up regularly so that it decreases completely.
He should be careful while using methotrexate, as the reason for arthritis was not known and should take folic acid along with it and with any adverse effects should stop it. The response to the prescribed drugs should be monitored closely. Try using ice packs regularly for the inflammation of the ankle joint.
I would like to quote: abstract the copyright 2001 of S.Karger AG, Basel :
BACKGROUND: A causal association between acute diverticulitis of the sigmoid colon and arthritis has rarely been reported. CASE REPORT: We report the case of a 60-year-old patient who developed migrating arthritis of the knee and ankle during the recurring episode of acute diverticulitis of the sigmoid colon. Treatment with NSAIDs and antibiotics had little effect on joint disease, but medical treatment was successful in reducing the diverticulitis-related symptoms. Arthritis promptly improved after surgical resection of the sigmoid colon, and 30 months later the patient is free of symptoms in the previously affected joints. CONCLUSIONS: Five cases of diverticulitis-associated arthritis have been reported. The similar case reported here reconfirms that joint disease has a limited response to medical approaches. Colon resection is recommended for patients with diverticulitis-associated arthritis which does not respond promptly to antibiotic therapy. Copyright 2001 S. Karger AG, Basel
Interesting post. I just stumbled on this. I was diagnosed with Diverticulosis (with bouts of Diverticulitis) and not long afterwards, diagnosed with Rheumatoid Arthritis. I do have several other Auto Immune illnesses, but I have never even thought of those two in the same sentence. My Grandmother had the exact same combination. My bouts of Diverticulitis are getting more and more frequent and the RA is severe. My Gastroenterologist knows I have RA, but has never mentioned this. I'm guessing in my case they may not be related?? I definitely had the Diverticulosis first. I have Endoscopies about every 6 months or less due to it and all the Polyps in my throat and gallbladder and Colonoscopies every year to check on the severity of the D. and colon polyps. I'm just a polyp mess. :) I will bring this up to my Gastro and Rheumy and see what they say.
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