Suggest treatment for ulcerative colitis and arthritis
? Enteropathic Arthritis
Thank you for writing on health care magic
I have gone through your history and i would like to know certain details before i can guide you to the next line of treatment
1. Did you have crohns disease or ulcerative colitis??
2. Did the arthritis come before the Bowel symptoms or started after it?
3. When you said not working well, could you explain that in detail. Is it your joint symptoms which are flaring or the bowel symptoms//??The management will differ a bit in both
4. Are you taking any painkillers as of now??
5. What are the other autoimmune disorders u have??
6. do you have HLA B 27 to be positive?
Do let me know these details as i will be able to guide you better when i know the complete history
1. I have ulcerative colitis.
2. The bowel symptoms started many years before the joint problems.
3. The bowel symptoms are still very well controlled with the sulfasalazine, but the joints have flared back up again. The sulfasalazine even actually helped lessen my endometriosis symptoms, but those have gotten bad again as well.
4. No painkillers except Advil at night to help lessen the pain enough to sleep. Naproxen and Meurontin were causing me far too many side effects, and Percocet is bad stuff.
5. Fibromyalgia, Chronic Fatigue, Endometriosis, Psoriasis, and an unidentified migraine/myoclonic seizure disorder that has stumped the neurologist and only started out as a shaky hand about 2 years ago.
6. If that is something specific to RA, (???) then no, I do not have it. The rheumatologist I saw said I had inflammation showing in bloodwork, but RA factor was negative.
Thanks so much for your help
Good evening XXXX
Thanks for the detailed history.
HLA B 27 is a gene which is present in the type of arthritis you have. It has implications in some forms of treatment we prescribe and also it carries on in the family.
If your bowel symptoms are well controlled and joints are flaring up, there are 2 ways we can approach it(I am not too sure if your rheumatologist labelled your joint symptoms to psoriasis or secondary to ulcerative colitis)
Some doctors may increase Sulphasalazine to 3 gm daily( that is the maximum dose) but our experience says it is a very good drug for ulcerative colitis but milder drug when it comes to joints.
So the first step i feel is to add another drug.. Methotrexate. It is once a week medication. You can discuss this option with your rheumatologist. It is an excellent drug for psoriasis and if your joint symptoms are due to psoriasis, it will help them as well.But yes, we need to clearly delineate the arthritis is arising due to bowel disease or if it is psoariatic arthritis. As you are saying your bowel symptoms are good, there is a less likely chance it is due to ulcerative colitis as patients have flare of both the symptoms together.
If Methotrexate doesnt work and your joints continue to be swollen, the best option is considering a biologic( Infliximab) It will help in both Ulcerative colitis and your arthritis
These are the best options i feel. But yes, the first and foremost thing i would like to do before recommending you any new medication is examining your joints to look for swollen and tender joints as it is the most important criteria before adding a new medication.
You can discuss it out with your rheumatologist keeping these options in mind. I would strongly suggest to get an HLA B 27 checked as well.
Do let me know for more queries.Would be happy to help you out here
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