Crohn’s disease, an inflammatory bowel disease (IBD), leads to inflammation in your digestive tract and sometimes in other areas in your body.
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Typically, Crohn’s causes early symptoms like diarrhea, unexplained weight loss, and abdominal pain or cramping, but other early symptoms can be easy to miss.
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While Crohn’s disease usually causes gastrointestinal (GI) symptoms, the first noticeable signs can vary widely, and some people may experience symptoms outside the gut (extraintestinal manifestations) before they experience gastrointestinal symptoms, says Katherine Falloon, MD, a gastroenterologist specializing in inflammatory bowel disease at the Cleveland Clinic in Ohio.
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According to research, about 24 percent of people with an IBD experience symptoms outside the gut before they’re diagnosed. Most people experience them an average of five months before, but some see signs they may not realize are symptoms of IBD up to about two years before diagnosis.
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Early (prodromal) Crohn’s symptoms include mouth sores, joint pain or stiffness, loss of appetite, nausea, fatigue, anemia, skin rashes or red, tender bumps, especially on the legs, says Udayakumar Navaneethan, MD, a gastroenterologist with the Orlando Health Digestive Health Institute in Florida. The sometimes subtle nature of these symptoms can lead to delayed diagnosis, which can make treating the disease more difficult.
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In one survey of 5,576 people with IBD, 48 percent indicated that they had to wait more than a year to get diagnosed, and 25 percent waited up to five years, even after seeing doctors more than once.
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But the more you know about early symptoms of Crohn’s disease, the better you can advocate for yourself.
1. Appetite Loss
A complex web of hormones and nervous system signals makes you feel hungry or full, and inflammation from Crohn’s can interrupt these communication pathways and affect your appetite.
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But unpleasant symptoms like nausea, abdominal pain, bloating, diarrhea, and mouth ulcers can also make eating sound less than ideal, says Dr. Navaneethan.
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Crohn’s can also cause intestinal inflammation or strictures (narrowing), says Dr. Falloon. “This can interfere with normal digestion, leading in turn to poor appetite.”
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2. Abdominal Pain
In early Crohn’s disease, mild abdominal pain can come and go, with pain-free periods lasting weeks or months.
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As Crohn’s inflammation persists, pain can get worse, says Navaneethan. “Chronic inflammation seen in Crohn’s can lead to swelling, ulcers, and abscesses in the intestinal walls and visceral (internal organ) hypersensitivity, causing abdominal pain.”
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3. Fatigue
Fatigue is a common early symptom in Crohn’s disease, and one research review found that between 48 and 62 percent of people newly diagnosed with the condition reported experiencing it. As GI tract inflammation persists, fatigue can get worse, says Falloon.
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Anemia and other nutritional deficiencies can also cause Crohn’s fatigue. But more research on the symptom in IBD is needed to understand additional risk factors and develop interventions to manage them.
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4. Fever
In early Crohn’s disease, inflammation provokes an immune response, which can cause a low-grade fever.
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Most healthcare providers consider a fever to be anything above 100.4 degrees F, when taken with an oral thermometer.
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But your body temperature can also rise to the level of a high-grade fever (over 102.4 degrees F) if you develop a Crohn’s-related infection, such as an abscess, says Falloon.
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Fevers can help fight infection, but always seek medical attention for a fever over 104 degrees F.
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5. Joint Pain
Crohn’s inflammation can affect more than just your GI system. “Inflammation can extend to joints and can cause joint pain,” says Navaneethan. Joints that are often affected by Crohn’s inflammation include the spine, knees, ankles, wrists, and elbows.
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Joint pain is a common non-GI symptom of Crohn’s disease, says Falloon. Musculoskeletal symptoms, most often joint pain, affect up to 50 percent of people with an IBD.
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“While there are different theories as to exactly why this occurs, it is thought to result from inappropriate immune system activation.” Joints can be painful even when GI symptoms are in remission, Falloon says.
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6. Eye Pain and Redness
Inflammation can also occur in the eyes, causing pain and redness, says Navaneethan. Between 4 and 12 percent of people with Crohn’s disease report eye problems, which include inflammatory conditions.
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The most common eye issues associated with Crohn’s include inflammation of different layers of the eye, such as uveitis, episcleritis, and scleritis, says Falloon.
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“Eye pain and change in vision require prompt evaluation by an ophthalmologist, as these may be signs of inflammation that can lead to irreversible damage.”
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7. Red Bumps on the Skin
About 5 to 15 percent of people with Crohn’s experience red bumps on the skin called erythema nodosum. “These tender red nodules usually appear on the shins,” says Navaneethan. Erythema nodosum usually appears with active Crohn’s but can also begin before diagnosis, Navaneethan says.
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“Erythema nodosum [is] the most common skin manifestation of inflammatory bowel disease,” says Falloon, but it typically resolves with treatment of Crohn’s disease.
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The Takeaway
- Early symptoms of Crohn’s disease can be easy to miss, leading to a delayed diagnosis, which can make treatment more difficult.
- The most common early Crohn’s symptoms include poor appetite, fever, fatigue, red bumps on the shins, and abdominal, joint, and eye pain.
- If you notice these symptoms, you can ask your doctor for an evaluation to determine whether they might be signs of Crohn’s disease.
