Hi. My husband has crohn's disease, and recently got over a bout of c-diff. For the past 2 weeks, he's had joint inflammation. It started in his SI joint, and then his neck hurt, and then his knee grew to the size of a football, and he couldn't bend it or straighten it. After tests, the docs have ruled out lupus, drug induced lupus (he is on remicade), and RA. They aspirated the knee, and ruled out septic arthritis and gout. So, he's now left with IBD related to arthritis or Reactive arthritis.
He has so far gotten fluid aspirated from his knee 3 times, the latest being about 12 hours ago. He also has had a cortisone shot into his knee. His neck and back are improving with the steroids that they have him on. The rheumatologist upped his steroids to 40mgs a day. However, his knee effusion just keeps filling up. Once you relieve the pressure, things get better (the knee is still weak after that), but much better. So far, in the past week, it's been done 3 times, and he's gotten cortisone. But I noticed again tonight that despite being less than 24 hours since aspiration, his knee is huge again! He says it's not as tight as last night, but it's probably only another day until it gets that bad again, and off we go to the ER again.
So, here's are my questions to you folks who know more about arthritis than I've managed to cram since his symptoms began. What do you do for persistent knee effusions? Do you just keep going back to the doc to get it aspirated for relief? Is there a limit on how often a joint can be aspirated? Is there a do it at home kit? :-D
I also read that the joint should be wrapped using a compression wrap after aspiration, but so far, none of the doctors have recommended this. He ices it to try to keep the inflammation down, but that's all they've said so far. Would it be advisable to wrap the joint the next time he gets it aspirated?
Also, I read that NSAIDs are more effective at controlling joint effusion related inflammation than steroids. But he is a crohn's patient, and can't take NSAIDS. The rheumatologist wants to put him on MTX. Is that better for at controlling joint swelling than steroids? I thought steroids were the fast acting thing and that mtx can take several weeks (upto a dozen) to work. Am I wrong?
Oh, also they bumped up his remicade from 8 weeks to 6 weeks. His next infusion is next tuesday. Do you think remicade will help with the effusion?
Thanks for your answers.
Husband with Crohn's
Diagnosed March 2003 Ulcerative Proctitis
Diagnosed March 2008 Crohn's & C-diff, hospitalized 45 days
Canasa, Lialda, Remicade, VSL#3, Florastor
In Remission since June 2008
Stopped vancomycin for c-diff Jan 1 2009
C-diff free, until Sep 2, 2009
Fighting c-diff, I guess for life