There is a growing awareness that colitis can occur without any observable lesions on colonoscopy. Microscopic colitis is occasionally associated with spondylitis and may be associated with myofascial back pain by activating psoas and abdominal wall spasms. How then does one make a diagnosis?
In:
Collagenous Colitis and Spondylarthropathy
Arthritis Care & Research
Vol. 55, No. 3, June 15, 2006, pp 507–512
JAVIER NARVA´ EZ et al
Classified as a disease of unknown etiology causing “chronic watery diarrhea, crampy abdominal pain, and weight loss in the absence of endoscopic abnormalities”.
Microscopic colitis comes in two forms:
1) Lymphocytic colitis – lymphocytes seen on biopsies
2) Collagenous colitis – in addition a layer of collagen seen on biopsy. There is more literature on this disease.
It apparently is controversial if the differences matter.
There appears a connection between this and various Connective Tissue and autoimmune diseases – thyroid, polymyalgia, RA, sarcoid, Lupus, Sjogren’s, recurrent Uveitis, and idiopathic pulmonary fibrosis.
More disturbing is it’s association with ” diverse musculoskeletal symptoms”. Given the number of referenced reports they classify it as potentially “new type of enteropathic arthropathy”.
It is much more common in women and may occur after a bout of “intestinal disease”.
ESR/CRP may show some elevation and HLA B27 usually negative. Most common association would be sacroilitis though other joints can be involved(~10%). Hopefully with sacroilitiis, one could get a history of low belt line back pain and morning stiffness.
NSAID’s, sulfasalazine (2 gm/day), mesalazine (2,400 mg/daily), and Prednisone have been used with some positive and negative results. Sounds like sulfasalazine (2 gm/day) and prednisone (5 mg/day) was their favorite mix.
There are some cases of chronic pain and chronic diarrhea labelled as Irritable bowel and “Fibromyalgia”(FM) that look suspiciously like sacroiliitis because their FM is worst in lower back. I have two cases that I did stool leukocytes that are positive but colonoscopy is negative.
Re back – I have tried NSAIDs or a IM. Kenolog shot of 60 mg in these cases and if back pain clears one would think that would make it more likely.
I find dealing with this problem very frustrating and would welcome any suggestions.
Change diet. Try “Specific carbohydrate diet” developed by Elaine Gottschall. I found headaches and arthritis went away as well as the diarrhea, abdominnal discomfort, stomach aches and back pain.