Irritable Bowel Syndrome and Axial Spondyloarthritis

After my diagnosis of AxSpa, and once I was already taking Humira (one of the biologics), I experienced some gastrointestinal (GI) issues. Aside from the symptoms of AxSpa around my spine and peripheral joints, I started to have pain in the abdomen, difficulty to digest and feeling bloated. My bowels were irregular, I could not anticipate when a new episode would come, and I could not link it to a particular change of my diet. Each time, it would make me feel tired. It was as if I was not making the most out of the food I was eating in terms of nourishment and energy.

After discussing it with my doctor, I went to see a gastroenterologist. I did some blood and stool tests, and these did not show any markers for inflammation at the time. So, I guess that meant that I did not have inflammation in my bowel, which was good news. I have met people with AxSpa who also have a diagnosis of Crohn’s disease, or Ulcerative colitis, both the result of inflammation in the bowel.

There were a few potential theories

Knowing my tests results, after discussing with the gastroenterologist I decided not to have the colonoscopy and endoscopy that were offered to me. We suspected irritable bowel syndrome (IBS) in my case. Various causes were possible:

1. I have fibromyalgia on top of AxSpa and people with fibromyalgia can develop IBS symptoms.
2. With Humira we are more sensitive to some type of food which can cause food poisonings and /or digestion problems, so I did wonder if Humira was the cause of my GI symptoms.
3. The level of stress and anxiety could play a role in the IBS symptoms I was experiencing. One hint related to the psychological aspect of these symptoms is I noticed that once on holiday, when I was abroad relaxing and paying less attention to my diet, my GI symptoms disappeared.

What helped my IBS and AxSpa

Now it seems I have managed to have these GI symptoms under control and I rarely get them. Here are few things that I think may have helped me:

• I went to see a Dietitian and I did the low FODMAP diet. The FODMAP diet was designed by researchers to find any food that may trigger GI symptoms and in particular those found in IBS. You can find more information here. I did not find a particular type of food that can trigger my symptoms, which is useful to know. However, the Dietitian invited me to reflect on my load of the FODMAP type of food daily and maybe reduce it so that would help my digestion process. As a result, I changed few eating habits for the better.
• I attended a self-management program for chronic pain and we used Cognitive Behavioral Therapy (CBT) to manage better our symptoms including stress and anxiety linked to our condition. I now feel less stressed and anxious, more in control whilst living with my conditions. This can only have a beneficial impact on my GI symptoms. If indeed I was living with IBS symptoms, then addressing my mental health issues has certainly helped with those.
• I decided to reduce or avoid some food that is not recommended with Humira, which are the types of food that have a higher risk of infection or food poisoning (shellfish, unpasteurized dairy products, any food with raw eggs/meats/fish).

In the end, it is hard to say which approach has worked out best in reducing my GI symptoms. I think it is a probably a combination of the things I have been doing alongside with getting educated about this kind of symptoms that we can have when living with AxSpa.