Update on probable crohn's, question about prednisone

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rootsmith
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Date Joined Jan 2004
Total Posts : 598
   Posted 5/23/2008 3:31 PM (GMT -7)   
Hello:
 
I haven't been around in awhile. We moved and are trying to sell our house so its been busy.
 
I had an appt with the rheumatologist I saw in 2004 for an inflammatory arthritis of my knee. He predicted IBD back then, at which time I had no gi symptoms. They gradually developed and in early 2007 I was diagnosed with probable crohn's based on my response to medication. (colonoscopy normal, biopsies normal)  I've had what has been diagnosed as plantar fascitis for 1 1/2 years.  Been to the foot doctor, not much help there.  I am now on Lyrica which helps a lot with the neuropathy supposed to be caused by the inflammation in my feet (or else its caused by some thing else)  Unfortunately it does nothing for foot pain.
 
So I told the rheumy everything that has gone on since I saw him and that my gi strongly advises against NSAIDS, even Celebrex and Salicylates (i.e. Salsalate) He said that it would be what he would normally prescribe but since my gi says no, that changes things.  His next question was "Has anyone spoken to you about Remicade or Humira?" WHAT?  I told him that my gi office told me I was nowhere near that stage. He said maybe not for your gut, but this problem qualifies you but first you have to fail the oral meds.  So, since no NSAIDS, the next step is an immunosuppressant but before he could justify that he would have to give me a 10 day prednisone trial to see if that relieved the foot pain.  If not, it is a mechanical problem.  If yes, the next step would be either methotrexate or immuran. I couldn't believe I was hearing this. I want to be out of pain and if this is the route I have to take, sign me up.  My gut is ok.  I also have IGG food sensitivities and perhaps if my immune system was suppressed, I could eat the foods that I have to restrict.  No gluten, casein, egg, corn syrup makes for a very restrictive diet.
 
So, my question is how long does it take one of these trials to work for arthritis type pain?  I'm on 30 mg day 1-3, 20mg day 2-5, 10 mg day 6-10.  I once took methylpred and the course was shorter. Is methylpred stronger?   I'm on day 2 of the prednisone taper and my foot pain is probably about 75% relieved.  I know prednisone can act quickly with some problems, how quick is quick in this case? Does anyone know?
 
Thanks for your input. 
 
Rootsmith
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin, sertraline, lyrica  


Ides
Forum Moderator


Date Joined Nov 2003
Total Posts : 7077
   Posted 5/23/2008 7:06 PM (GMT -7)   
I was just put on a short burst of prednisone to deal with a rather severe flare up of my spondyloarthritis and enthesitis. I started at 30 mg and decreased every third day by 5 mg. On the 3rd day of taking the pred, I was feeling 90% better and the swelling in my joints had reduced almost to not being visible. I hope this answers your question.
Moderator Crohn's Disease Forum
CD, Ankylosing Spondylitis, small fiber peripheral neuropathy, avascular necrosis, diffuse connective tissue disease, Sjogren's Syndrome ?
 


sjkly
Veteran Member


Date Joined Dec 2007
Total Posts : 2113
   Posted 5/23/2008 7:33 PM (GMT -7)   
I always feel 75% better in about 4 hours then 90% in four days. In ten days you will know wether it will work for you but that doesn't mean you will be cured. In fact part of the trial is probably seeing how you respond to the quick withdrawl. Basically they are doing a reversal design experiment on you. If you get better on treatment then the pain returns with out it then it is highly probable its an inflamitory condition.
I hope they can do something to control your pain permanently.
Sj

rootsmith
Veteran Member


Date Joined Jan 2004
Total Posts : 598
   Posted 5/24/2008 5:35 AM (GMT -7)   
Thanks for your encouraging responses. My feet did feel better the first day, although I didn't really notice it until the morning after when I woke up without pain in my feet. Ides, I notice you have peripheral neuropathy listed. Does this improve on prednisone? I realize that it would be an indirect result of prednisone. Nerve pain is hard to treat. In my case, it could also be two different problems going on. The foot doctor I saw told me that the nerves get riled up with the inflammation in the surrounding tendons etc.

Yes, SJ, my response to this trial will determine the next step. I see him the end of July which will give plenty of time for the pain to return. It has to return or I'm sure the treatment plan will be put on hold. I would think a "mechanical problem" would respond to rest but that is not the case. Even when I have long stretches off work (I'm on my feet a lot at work) it does not necessarily improve. It also does not respond at all to tylenol.

Besides the improvement in my feet, I just feel better. I told him I had this feeling of what would probably be called malaise, despite the successful treatment with pentasa. I feel more normal. It will be interesting to see if this feeling of malaise will return. A previous doctor told me "anyone will feel better on prednisone, that's no indication" When he said that I had to think of all the horror stories I have heard about this drug. So far the only thing it seems to be doing that is negative is affecting my sleep which I hate. I realize its a small dose. I'm also a bit hungrier.

Thanks!

Chris
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin, sertraline, lyrica  


rootsmith
Veteran Member


Date Joined Jan 2004
Total Posts : 598
   Posted 5/26/2008 8:59 AM (GMT -7)   
I've taken prednisone for 5 days (3 at 30mg and 2 at 20mg) While on 30mg my feet were 90 % improved. On day #2 of 20mg the pain in my right foot is coming back but it is not like it was. I wish I could go back to 30mg to see if it improves again but that's not part of this trial.

I am surprised to find out how *normal* I feel. No malaise at all. Not supercharged, just normal. I haven't felt this way in a very long time. My gut also feels normal. I knew it wasn't quite right even though the gi NP thought I was doing great on pentasa. Now I have something to compare it to.

The only negative effect of prednisone I am aware of is the sleep disruption which stinks. I realize I haven't been on it very long though.

Chris
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin, sertraline, lyrica  


Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 5/26/2008 9:13 AM (GMT -7)   
Chris most folks have a few rough days with each wean down. I know I always do even when on short bursts. My Rheumy wants to treat me in a similar manner i.e. Methotrexate, Remi etc. But both my GI and I agree that that isn't the way to go for me. I really don't want to use those stronger meds, I will just continue using my pain meds, they seem to help enough.
Been living with Crohn's Disease for 32 years.  Currently on Asacol, Prilosec 60 mg, Estrace, Prinivil, Diltiazem, Percoset prn for pain and Calcium.  Resections in 2002 and 2005.  Recently diagnosed with Fibromyalgia and doing tests to see if I have Inflammatory Arthritis or AS.


rootsmith
Veteran Member


Date Joined Jan 2004
Total Posts : 598
   Posted 5/26/2008 9:15 PM (GMT -7)   
I realized just after I wrote the last post that I was starting to feel as bad (perhaps even worse) than I did before going on prednisone. First there were the slight pains in my right foot I wrote about above, then I noticed that feeling of malaise developing, then my gut starting up. At the end of the evening my feet are killing me but I will remember what you wrote, Nanners. Perhaps this is temporary.

It is unbelievable (to me) that this could happen on such a short trial. I was on 30mg for 3 days. Then the first day on 20mg was fine, just like the 3 days on 30mg Halfway through the second day on 20mg (today) everything started coming back. It'll be interesting to see how well I sleep tonight. Before prednisone I was sleeping great on 150 mg lyrica before bed.

I felt so normal.....ARGH
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin, sertraline, lyrica  


rootsmith
Veteran Member


Date Joined Jan 2004
Total Posts : 598
   Posted 5/27/2008 4:11 PM (GMT -7)   
You are right, even though my feet still hurt, I don't feel as bad systemically as I did last night or even this morning (its early evening writing this) Tomorrow I go down to 10mg. It'll be interesting to see what happens. I wonder if I passed the test.
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin, sertraline, lyrica  

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