First proper flare since Crohns diagnosis

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Hi everyone.

I’m 43 years old, and I have been diagnosed with Crohns for 2 years officially, although my symptoms build up gradually from around 35. Things kicked off a few weeks before my 40th birthday. I attribute it to a bad kidney infection which took 2 antibiotics to clear, along with a genetic tendency towards developing Crohns. Getting a diagnosis was quite quick compared to a lot of people here - 2 months from attending my GP, positive QFIT results and colonoscopy, including a one month postponement to the colonoscopy because I tested positive for Covid during pre-screening. I was diagnosed as mild to moderate indeterminate colitis initially, with biopsies taken for assessment.

Referral to a gastroenterologist was slow unfortunately. Wished I had private health insurance to speed things up as it took 11 months from colonoscopy to 1st appointment. My GP put me on 2g Pentasa as I was struggling with symptoms, which was increased to 4g by the gastroenterologist. The 4g dose worked well enough for a while, though it took me a good while to build myself back up again, and I had to accept that life looked different - no more going out in the evening or eating later than 6pm, falling asleep on the sofa at 9pm and carefully watching trigger foods and managing my energy.

Unfortunately things have deteriorated significantly in the last 3 or 4 months. I tend to ignore things and hope they resolve themselves, so by the time I contacted the nurse specialist for help, I was having diarrhoea multiple times a day with obvious bleeding. Calprotectin came back at 2600+, along with some elevation of CRP (7), so I am now on 40mg steroids for 8 weeks. I’m 5 days in, and I had hoped for a more dramatic improvement, but it feels very slow. Diarrhoea has decreased for 10+ times a day to 3-5 times, but I’m exhausted all the time. I’m off work at the minute - hard hoped to be back next week, but beginning to wonder if that’s realistic given my 2 hour commute and patient facing role. So that’s where I am now. Waiting to see how things pan out.
 
As the steroids (apparently slowly) bring your flair under control. you need to be thinking about a different and more effective maintenance treatment. Pentasa is pretty much useless for Crohn's disease. It's much more suited to treating ulcerative colitis, not Crohn's.

I recommend that you discuss with your gastroenterologist the advisability of going on a Crohn's biologic or biologic plus immunosuppressant. With symptoms as severe as yours, you need some strong medicine to get you into a solid remission and hopefully keep you there.
 
Thanks for your reply Scipio. The nurse specialist did say that Pentassa doesn’t tend to be that effective for crohns. How much longer would you recommend I give the steroids to work before contacting my nurse specialist / gastroenterologist? I’m on day 5 of 40mg of Prednisolone (2 weeks at 40mg, then taper down over 6 weeks). Thanks.
 
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If you are not feeling lot better on the steroids by the end of the two weeks at 40 mg, the gastroenterologist should be thinking about another approach to to get you into remission.
 
Definitely ask about another maintenance med
Since those can take 6 weeks to months to work
Better to start now while on steriods so when you taper you don’t flare again

drug pyramid is 5-asa (Pentasa ) least effective but some still like to try it
Immunosuppressants (6-mp, imuran ,methotrexate) these can take months to work
Some have luck with those
Some do not
Then there are biologics
Depending on the country depends what is available-remicade /humira start for most

my kiddo was dx at 7
Now 20
Has been on most above
Goal is to find a med that works for you
My kiddo has been on Stelara plus methotrexate for 6 or 7 years now
Good luck
 
Thank you for your advice Scipio. I’ll see how well things improve by the end of the 2 week 40mg dose and then chase it up with my gastroentorologist.

Thank you my little penguin. I’m just starting to get my head around the drug pyramid. I’m finding the treatment section and individual people’s treatment journey on the forum helpful for increasing my knowledge. Glad to hear your child has got something to work for them.
 

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