Why do so many Crohn's patients have rheumatologists?

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78SilvAnniv
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Date Joined Apr 2008
Total Posts : 289
   Posted 7/31/2008 8:30 PM (GMT -7)   
I have been reading many threads here, trying to learn about CD.  I was recently Dx'd with CD, after years of believing (and having it treated as) UC.  Why do so many CD patients have referals to Rheumies and Rheumy physicians?
I don't have one.  Do I need one?  Do some CD patients not need one?
Heidi


I have the ability of single-minded determination and accurate project focu....Hey, look, a cat!
 
Crohn's and UC are pretty darn crappy, but if you can't laugh at yourself, you'll cry. 
I'd much rather laugh.
2001 Dx'd with UC.  No remission.  5/2008 surgery, removal of 6" of left side colon.  Dx changed to Crohn's.  Remission for 8-9wks after surgery, symptoms returning after resuming 6MP.


crohnspatient13
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Date Joined Jul 2008
Total Posts : 128
   Posted 7/31/2008 8:45 PM (GMT -7)   
i've been wondering the same thing, thanks for putting the question out her. i don't know why either i'd assume "rheumies" would be for people with RA?
diagnosed with Crohns since 2004
Hospitalized often for colon rest and TPN
Have been on 6MP, flagyl, cipro, prednisone, remicade (3 1/2 years).
Now trying Humira every two weeks.


Celey
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Date Joined May 2007
Total Posts : 1284
   Posted 7/31/2008 8:55 PM (GMT -7)   
Holy cow... You have my same first name....

Anyway.... sometimes, there are Crohn's disease patients that start having pain in their joints for reasons other than just a side effect of the meds... Not everyone does. But unfortunately some do...

*I'm one of the unlucky ones*


And it's not just RA.... Rheumatologists treat all sorts of arthritis and joint problems.....
I think I am being picked on by life, sometimes. But's that okay. Life and I are good buddies... I know life doesn't mean no harm. It just is the way it is. I can accept that.


Jen77
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Date Joined Mar 2006
Total Posts : 2689
   Posted 7/31/2008 8:55 PM (GMT -7)   
A lot of people with Crohn's develop arthitis issues, like RA. Pretty darn common actually. I've got my referral recently, didn't get one till my joint inflammation kicked in with a flare. Crohn's effects outside of the intestines in many ways, which causes us to have to see many different kinds of doctors unfortunately.
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Currently taking Prednisone: tapering down again at: 6mg now, Asacol, Questran, Toprol XL (for high blood pressure).


Celey
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Date Joined May 2007
Total Posts : 1284
   Posted 7/31/2008 8:59 PM (GMT -7)   
On the CCFA website it says only 25% of people with Crohn's develop arthritis issues... I think... there's just a lot of them that visit this board...

Or maybe the CCFA website is wrong... at any rate...

You guys shouldn't worry about it unless you start having joint pain symptoms...
I think I am being picked on by life, sometimes. But's that okay. Life and I are good buddies... I know life doesn't mean no harm. It just is the way it is. I can accept that.


bowlies
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Date Joined May 2007
Total Posts : 69
   Posted 7/31/2008 9:20 PM (GMT -7)   
My son who was diagnosed with CD two years ago had no joint pain initially and only 4 months ago developed it as his Remicade would wear off each month. As soon as he got his Remicade the joint pain would disappear within a few days. The joint pain would preceed D and stomach pain as inflamation would increase. In many Crohns patients the arthritis is a symptom of inflamation rather than a new disease entity. Usually if you deal with the gut inflamation the joint inflamation subsides. In most cases they are one disease rather than two.

crohnspatient13
Regular Member


Date Joined Jul 2008
Total Posts : 128
   Posted 7/31/2008 9:20 PM (GMT -7)   
haha well, that answers my question, thanks... but at least there's some good news because arthritis runs in my family anyway and i thought it could just be from medication but sometimes i have unbearable pains in my joints, like my knees and wrists, but most often my fingers and it's horrible i need to take of my rings and try and roll my fingers around and sometimes try and crack them because i can;t get any relief. maybe early signs of developing arthritis? i sure hope not i hope it's the meds but who knows maybe i'll eventually have to see one...
diagnosed with Crohns since 2004
Hospitalized often for colon rest and TPN
Have been on 6MP, flagyl, cipro, prednisone, remicade (3 1/2 years).
Now trying Humira every two weeks.


Celey
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Date Joined May 2007
Total Posts : 1284
   Posted 7/31/2008 9:28 PM (GMT -7)   
How long has the pain been going on? If it's been going on for a few months, you should talk to a doctor about it...
I think I am being picked on by life, sometimes. But's that okay. Life and I are good buddies... I know life doesn't mean no harm. It just is the way it is. I can accept that.


bowlies
Regular Member


Date Joined May 2007
Total Posts : 69
   Posted 7/31/2008 9:43 PM (GMT -7)   
Maybe it is not an early sign of Arthritis but rather a sign that the inflamation in your gut is present. Did you recently switch from Remicade to Humira? Maybe the Humira has not yet taken effect. Do you take the Humira with either Imuran or Methotrexate?

Keeper
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Date Joined Jun 2008
Total Posts : 1058
   Posted 7/31/2008 10:26 PM (GMT -7)   
I'm pretty sure that the two are connected. My guess is that the gut inflammation causes the joint inflammation directly. Crohn's is associated with high IgE levels in the blood. IgE is a trigger for the mast cells which are known to be active in the progress of RA. Unfortunately, there is no simple solution like an IgE inhibitor - not that they don't exist. It is just that there is no complete extinction of the response. The observations have shown either an initial relief followed by a worsening or no initial relief and a slow improvement thereafter. They really don't know why and I guess that they don't want to make matters worse. There is likely another modulator or several that is involved in the process.

crohnspatient13
Regular Member


Date Joined Jul 2008
Total Posts : 128
   Posted 7/31/2008 10:35 PM (GMT -7)   
yeah well ive had this pain/cramping for over a year now... and i guess it does seem to get worse during flares. im on humira and just started, i just took my 2nd dose today because remicade stopped working. does it help to be on imuran or methotrexate while on humira? because i was on 6mp with remicade, and now am not on any immunesuppressant and humira hasnt shown any signs of improvement yet. but yeah the pain in my fingers especially can get really bad and cause me migranes from the intense stiffness and cramping.
diagnosed with Crohns since 2004
Hospitalized often for colon rest and TPN
Have been on 6MP, flagyl, cipro, prednisone, remicade (3 1/2 years).
Now trying Humira every two weeks.


Jen77
Veteran Member


Date Joined Mar 2006
Total Posts : 2689
   Posted 7/31/2008 11:12 PM (GMT -7)   
Celey said...
On the CCFA website it says only 25% of people with Crohn's develop arthritis issues... I think... there's just a lot of them that visit this board...

Or maybe the CCFA website is wrong... at any rate...

You guys shouldn't worry about it unless you start having joint pain symptoms...

I wonder if that includes issues caused by the medications we have to take, and just some joint pains but don't lead in to more serious problems (how many people shrug some of the more minor aches and pains off? At least at first anyway).
 
Or like you said, we are all just "lucky." LOL
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Currently taking Prednisone: tapering down again at: 6mg now, Asacol, Questran, Toprol XL (for high blood pressure).


Celey
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Date Joined May 2007
Total Posts : 1284
   Posted 7/31/2008 11:19 PM (GMT -7)   
Yeah... I have to wonder that, too... I mean, that's what I did when I first started having joint pain... but... as it got worse, I can't handle it anymore...

*Didn't mean to sound debative or anything Jen, ya know I like ya... :)... I just don't want people to worry too much...* Because I worry a lot, and it sucks... //^_^\\'
I think I am being picked on by life, sometimes. But's that okay. Life and I are good buddies... I know life doesn't mean no harm. It just is the way it is. I can accept that.


Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 8/1/2008 6:38 AM (GMT -7)   
We see the Rheumy for inflammatory arthritis, osteoarthritis and even other types of arthritis. The joint pain isn't always related to inflammation or medications. I suffer with fibromyalgia and osteoarthritis secondary to my Crohns. I am on no meds for any of it except for pain killers as I am not quite ready to go on the big gun medications yet. I have also found that I have alot more wear on my bones than someone my age should have. That more than likely is caused by alot of Prednisone use.

I personally believe everyone should have a Rheumy on board. If you aren't having joint pain now, I think you will sometime in your life. Mine pretty much developed in the last 10 years or so. And its getting worse as I get older.
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.


bektold
Regular Member


Date Joined Jul 2007
Total Posts : 456
   Posted 8/1/2008 6:40 AM (GMT -7)   
My Rheumatologist is also keeping an eye on my bone density.  Prednisone can really weaken bones.  Also, Calcium deficiency can be a problem for us, either due to absorption problems or trouble digesting milk products.  A PCP could probably also monitor bone density, if they know enough about the disease to know that it might be a problem.  But my Rhuemy has a density scanner right in her office, so I don't have to make a separate appointment at another facility to get it checked.

MMMNAVY
Veteran Member


Date Joined Jul 2006
Total Posts : 6927
   Posted 8/1/2008 7:25 AM (GMT -7)   
Bone density checks are very important even in younger crohnies.

But I have a rhuemy because I had such horrible joint pain I could not walk, no pain killer was touching it, except that it made me sleep. Little did I know at the time I had lupus from the remi.
Forum Co-moderator - Crohn's Disease
We will find a way, or make one.-Hannibal (crossing the Alps in the 15th Century on war elephants) 
Make sure your suffering has meaning...-?
All suggestions/options/opinions are caveated with please consult with your local health care provider...


Jen77
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Date Joined Mar 2006
Total Posts : 2689
   Posted 8/1/2008 9:28 AM (GMT -7)   
Celey said...
Yeah... I have to wonder that, too... I mean, that's what I did when I first started having joint pain... but... as it got worse, I can't handle it anymore...

*Didn't mean to sound debative or anything Jen, ya know I like ya... :)... I just don't want people to worry too much...* Because I worry a lot, and it sucks... //^_^\\'

Oh no, not at all. No worries! :) I hear ya on the worrying too much too, I'm a chronic worrier myself. LOL
~Jennifer
 
Diagnosed with Crohn's Disease 2/06 after sever GI bleed. Has been suffering since 1998. History of rectal fistula and gallbladder removal. Currently taking Prednisone: tapering down again at: 6mg now, Asacol, Questran, Toprol XL (for high blood pressure).


ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 8/1/2008 10:35 AM (GMT -7)   
I had the joint pain a few years after the Crohn's pains started, but hadn't been diagnosed with Crohn's yet and no one put the two together.  I was tested for Lupus, RA, etc. for swelling, painful joints.  Only after I started seeing a new GI who has Crohn's and knows more than my last GIs, did he tell me that a lot of Crohn's patients get arthritis also.  He really doesn't do much for the arthritis, but has me see the rheumy for that.  He's even told me that he has some patients with Crohn's who have no gut symptoms, just arthritis.  With me, the arthritis is worse than the Crohn's right now.  But, the arthritis meds are also causing stomach pains and ulcers, so it's a struggle finding the right meds. 

Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 


Keeper
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Date Joined Jun 2008
Total Posts : 1058
   Posted 8/1/2008 4:42 PM (GMT -7)   
I've just been reading about vitamin E and its inhibition of IgE. Since IgE is the major trigger for the mast cells which cause the RA, inhibiting the production of IgE safely would be a benefit. This is not a cure, but reducing the trigger should help the problem or at least slow the progression. Sorry no recommended doses - it seems to be a bit new and I could only see the article abstract: http://linkinghub.elsevier.com/retrieve/pii/S0140673600031329

Julia Hill
Veteran Member


Date Joined Mar 2008
Total Posts : 543
   Posted 8/2/2008 9:40 AM (GMT -7)   
I've had crohn's for 28 years and luckily I have not had much in the way of joint pain until appro. 1.5 years ago when I develped remicade induced lupus. Now that was painful, I could hardly move. I never want to experience that again, but that is when I added a rheumy to my list of specialists.

Julia

CAMEID
New Member


Date Joined May 2008
Total Posts : 8
   Posted 8/2/2008 11:29 AM (GMT -7)   
I think it might be that crohns
disease and arthritis are both auto immune. I would look into the low dose naltrexone people. some of them seem to be doing well yeah

Keeper
Veteran Member


Date Joined Jun 2008
Total Posts : 1058
   Posted 8/2/2008 1:29 PM (GMT -7)   
Sorry, I don't think that my last post was very clear. I am pretty sure that the IgE that Crohn's produces in the blood is responsible for RA developing. IgE is a trigger for the mast cells and it is established that the mast cells in the synovia are responsible for the development of RA. There are some proteins in gluten that resemble the cartilage proteins and thus Mast cells activated with IgE expressing that protein sequence cause the inflammation in joints. Stopping gluten in the diet is only part of the battle since cells in the blood continue to manufacture those IgE types for years after. That is why the report of vitamin E reducing the levels of IgE in the blood is exciting. It has the possibility of helping prevent or minimize the progression of RA.

yankeespg23
Regular Member


Date Joined Dec 2007
Total Posts : 63
   Posted 8/2/2008 8:33 PM (GMT -7)   
I guees I'm one of the lucky ones. I have Crohn's for 20 years now + never visited a Rheumatologist. No joint pain but plenty of the other symptoms. lol.

33 yr old Male from NYC, DX with Crohn's in oct of 1987, at age 12.
Resection in 1990 at age of 15.
Currently on Humira pen shots, 40mg weekly. Cipro 2x a day.
Multi vitamin daily,  B 12 pill 2x a day.
Anemic again, started iron IV infusions.


broomhilda
Veteran Member


Date Joined May 2007
Total Posts : 1488
   Posted 8/2/2008 9:01 PM (GMT -7)   
IMHO....PREDNISONE!
Dx'd Jan'06, 1st Resection 7/06, Humira, Imuran, B12 injections, Nexium, Lexapro, Glucosamine, Multi-Vitamin, Ultracet Secondary conditions: Psorasis, Osteoarthritis, Fibromyalgia, Lactose Intolerant, gallstones, peri-menopausal.


pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20576
   Posted 8/2/2008 11:27 PM (GMT -7)   
Arthritis issues, like RA and osteo are actually extraintestinal manifestations that can commonly go along with having IBD (UCers are also at a higher risk as CDers are than the average person), same with skin and eye issues as well, it's all part of the territory when you have IBD, it's fairly common for most and some are lucky and don't suffer with any extraintestinal issues because like most things, nothing's really written in stone and so much still needs to be learned.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)

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