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Achilles tendon enthesitis caused from crohn's disease

Hi everyone! I was diagnosed with crohn's disease before 11 years. My doctors used to say it was a mild situation by now. Unfortunately this May I went at ER with a lot of abdominal pain ,low fever , 10-12 diarrheas /24h (along with mucus) .The doctors said my Crohn's flared up ,as all the tests was negative .My CRP was 42 and that's the higher I ever got.My GI told me to take budedocine and so I did.The pain was really less and I can say I had a 70% improvement but not a complete remission .On this June, I had a mild pain at the Achilles tendon of my left foot. Within a week the pain was terrible and I couldn't even walk.2 months later,and after many orthopedics visits ,I noticed the same problem in the right foot.The diagnosis was active enthesitis of achilles tendons on both feet.We tried predizolon ,a topical injection of celestine chronodose,a medical walking boot for 1,5 month,physiotherapies , and many other drugs but nothing worked for me. Finally I visited a Reumatologist who told me that I have entheropathic arthritis .Thus ,I took my first shot of Humira before 10 days(80mg).Meanwhile my gut is ok (not in remission but I can live this way).My last CRP was 4.3 which is fine. Althought, I'm very worried because my GI told me that enthesitis usually resolved after the first shot of Humira but maybe it takes longer. Now I'm thinking that nothing much happened to me after the first shot and maybe isn't the right one for me .Furthermore ,I'm thinking all day about the side effects of the drug but I am willing to try everything to be able to walk again as before. Had anyone same experience before???I would be glad to hear I'm not alone and someone else has overcome the same problem.

my little penguin

Staff member
ERA can be related to crohns flares or flare independently .
Ds was dx with ERA associated with inflammatory bowel disease 7 years ago
Humira takes a long time to work
Think months 3 minimum in arthritis
Is your Rheumo prescribing the humira ?

Ds was on humira /mtx plus Celebrex for his arthritis
He is now on Stelera/mtx and Celebrex
Era is difficult not treat
But you need to give the meds time to work
Good luck
Yes ,my Reumatologist prescribed Humira for both ERA and crohn ,but my GI said the dose was wrong - i should have taken 160 mg as initial dose instead of 80 mg. Anyway ,he said he will correct the doses later if its neccasery. Yesterday ,orthopedist said Humira needs at least 2 months to work but both agreed that within 2 months I should have a progress otherwise that means it doesn't work for me.I feel very anxious and I'm thinking that maybe I will live with that many years or whatever .Also, I was thinking that Humira maybe not be able to treat enthesitis and maybe a DMARDs should be added along with Humira ,but yet it's too early to discuss it with my doctor.

my little penguin

Staff member
The arthritis dose for biologics is typically lower than the crohns dose
Without the proper loading dose (160 mg )
It will take much longer than normal (normal is 3 months average ) to see a response

Ds was only 9 when he started humira so like you they skipped the loading dose (he was on remicade prior ) and gave him the kiddo dose 20 mg every two weeks even though he was above the max weight on the box for kids
We were told the same
They would adjust later
Well three months later they upped it to the adult dose and that took three months to kick in
So a total of 6 months
6 months seems a lot for me considering that 3 months has passed since the enthesitis started and i just had the first injection of humira.Feeling confused about the terminology of entheropathic arthritis that Rheumo gave me .I don't suffer from joint's pain at all.My problem is the Achille's tendons but maybe ERA included in entheropathic arthritis .Also, I have to mention that the last three years had several tendons and muscles issues but never thought is related to crohn by now.Nothing left but wait and see if Humira takes effect to my problem.My GI told me to call him one week after the second shot of Humira .

my little penguin

Staff member
In arthritis world and Gi land
Entyvio and Stelara both take on average 8-12 months to work
Humira is 3 months
Remicade 6 -8 weeks
Methotrexate two months

spondyloarthritis Or ERA is the large umbrella term
It can affect the joints or the enthethes (places where tendons attach)
Or it can affect both
Ds has it affecting both
It can switch up from spot to spot

the Achilles’ tendon area is quite common area
So,I guess I have to wait much more to see how it goes.I hope Humira would be the right treatment even if it takes so long.At least I hope there would be a small difference after the second injection maybe...don't know....I wish this thing come to its end soon!!
Glota, I have enteropathic arthritis, as well, with Crohns, and had the same problem with my Achilles tendons in both feet. I put up with them for years, but then my left ankle got so bad I could hardly walk. My rheumatologist sent me for scans of both ankles, and I learned I had small tears all throughout so I got a hard cast on my left foot to completely immobilize it for 6 weeks, then I wore a boot for another four. The tears healed, and then I was sent to physical therapy to strengthen my ankles.

I was about to go the same casting route with my right foot (not as bad, but still had small tears), but then put it off due to COVID. In the meantime, the PT exercises I had eventually resolved it, I also do daily PT to help with enteropathic arthritis overall, and that has been the most effective treatment. I am adamant about doing the exercises every day -- if I ever skip a day, I really feel it. Anyway, if you are still having the same problems, you might want to ask for a referral to PT. It's really helped me, even more than the drug treatments (I am on Remicade for Crohns).
Hi kiltubrid,thanks for your reply.I'm still strangling with the same issue .I have been visited many reumo and orthopedic surgeons .None of them is sure what cause the pain .The thing is that I have a local inflammation right in the insertional sight of the Achilles tendon in the calcaneum and right behind I have ,not so big, bone spurs on both feet.I can feel the inflamed area when I wear closed shoes which make the spot and the round area irritated.So,I'm not sure if this causing the pain or what.... Except from this area ,I have no symptoms elsewhere and in my MRI there is no findings such as bursitis or synovitis in the ankle .Just a 20% degeneration of the Achilles tendon in the insertion and some fluid in the ankle which pretty much has gone before many months.I had many courses of physiotherapy with no success.Also,the exercises don't seem to help.Did you have that same symptoms ?I'm trying to figure out what's going on here with me.
Mate, this is a nasty disease, I can understand. But that doesn't mean that you have to let your arms down and give up. There are so many specialists and deceives on the market that can make you healthy again.