Crohn’s Disease and Restless Leg Syndrome Link?

By Lindsey Getz

Research has shown a connection between Crohn’s disease and restless leg syndrome.

As patients age, the number of diseases and conditions they may develop makes managing their health increasingly complex. But as research advances, so does the understanding of links between some of these health concerns.

That’s the case with Crohn’s disease and restless leg syndrome (RLS). The link between the two is a new discovery in the medical world. The connection raises several implications for physicians treating elder patients who complain of symptoms associated with either or both of these conditions.

Crohn’s disease has typically been thought of as a disease of the young. However, there’s a second peak of diagnoses of this chronic inflammatory disease of the gastrointestinal (GI) tract occurring around the time people reach the age of 60. Crohn’s disease is an ongoing disorder that can affect any area of the GI tract but most commonly affects the ileum, the lower part of the small intestine.

While it’s known that Crohn’s disease can affect areas of the body outside the GI tract, extraintestinal manifestations of the disease have not previously included the central nervous system. However, in a study led by Leonard B. Weinstock, MD, of Specialists in Gastroenterology based in St. Louis, it was discovered that there is a link between Crohn’s disease and RLS, a central nervous system disorder. This research was initially published in the February 2010 issue of Inflammatory Bowel Disease. More recent research will appear in a future issue of Sleep Medicine Reviews. The fact that both Crohn’s disease and RLS are associated with iron deficiency, inflammation, and bacterial overgrowth is the initial link that prompted the research examining the potential connection.

According to Weinstock, 54 different diseases, syndromes, and risk factors have been reported to cause or exacerbate RLS. In terms of patients with GI disease, these include gastric resection, liver disease, irritable bowel syndrome (IBS), celiac disease, and Crohn’s disease. “The link for these conditions could be due to iron deficiency, but our research in IBS, celiac, and Crohn’s patients suggests that bacterial overgrowth and/or systemic inflammation may play a greater role,” says Weinstock.

Make the Connection
When it’s discovered that a patient has Crohn’s disease, Weinstock says the physician should inquire whether he or she also has symptoms of RLS. Patients with RLS experience the compelling urge to move their legs that is often associated with leg discomfort while sitting or lying down. This condition has been shown to be more prevalent in certain patient populations, including patients with end-stage renal disease, iron-deficiency anemia, rheumatoid arthritis, diabetes, Parkinson’s disease, and fibromyalgia. 

When questioning patients about a potential RLS diagnosis, focus on the following four basic criteria, suggests Weinstock: the urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs; the urge to move or unpleasant sensations that begin or worsen during periods of rest or inactivity; the urge to move or unpleasant sensations that are partially relieved by movement, at least as long as the activity continues; and the urge to move or unpleasant sensations that are worse in the evening or at night. Symptoms such as pain due to arthritis and nervous activity that may mimic RLS should be ruled out, Weinstock says.

In the past, RLS, which is more likely to occur as individuals age, has been known to go undiagnosed or even misdiagnosed. But Weinstock says he’s found that a large number of patients already know they have RLS, even if they’ve never been asked by their physicians or officially diagnosed with the disorder. “In our multicenter study, we found that 43% of 272 Crohn’s patients have had a history of RLS, and there was a 30% prevalence rate compared with 9% in the control group. In the majority of cases, the RLS symptoms occurred during or after the onset of Crohn’s, indicating a connection. It’s also interesting that many patients indicated their RLS symptoms flare simultaneously when their Crohn’s symptoms flare.”

Weinstock says he initially made the discovery of a link between IBS and RLS. That connection got him thinking about other GI syndromes linked to changes in bacteria that could have an effect on RLS. “I naturally decided to study Crohn’s patients as well,” says Weinstock. “The result was the discovery that RLS occurs frequently in patients with Crohn’s. As a new discovery, it’s not yet listed in any review of extraintestinal manifestation of Crohn’s but is actually more common than some of the most well-known extraintestinal manifestations including arthritis, eye disease, skin lesions, and liver disease.”

After diagnosis, the course of treatment for the patient will vary, but Weinstock says antibacterial drugs such as rifaximin have been effective in treating bacterial overgrowth and GI symptoms in patients with Crohn’s disease and RLS.

Going forward, Weinstock says he’s hopeful the research connecting RLS with Crohn’s disease will lead to a greater understanding of fatigue and sleep disturbances associated with Crohn’s disease. Further investigation is warranted on the topic.

— Lindsey Getz is a freelance writer based in Royersford, Pa.