Yup, I'm w/you about
NOT wanting to take prednisone - but - Imuran can take up to 6 months to have any real effect, meanwhile damage is being done. I'm not even sure that Imuran can actually "treat" Crohn's activity all alone. It often needs "help" even after its taken full effect. Its more a maintenance med than a treatment med in my personal experience.
That being said, it would be a good idea to discuss this w/your gastro and ask how long he intendes for you to be on it. A reasonable alternative might be a short tapering dose of pred, switching to a tapering dose of Entocort EC and then Flagyl, Cipro or even Xifaxan and then add Pentasa along w/the Imuran to finish out the 6 months and for maintenance.
The fact that you have a fistula, regardless how bothersome or not, is one of the criteria used for the designation of "severe" Crohn's disease. And a fistula is NOT something to take lightly whether bothersome or not.
Since my Crohn's is mild and has been mild for 32 years I opted for Cipro for 6 months along w/the Imuran rather than Entocort or pred - but - Cipro is NOT w/o its serious possible side effects and serious muscle tears, especially of the Achilles tendon, are fairly common so I was VERY careful the entire 6 months to NOT stretch or overwork my muscles!
Flagyl was a miracle drug for my symptoms - BUT - I encountered peripheral neuropathy almost immediately w/it. Because it was so effective against the Crohn's I opted to stay on it at 1/2 the usual dose which greatly reduced the neuropathy to a tolerable level but doing so left me w/a mild neuropathy that lasted SEVERAL YEARS. It CAN be permanent for some.
We didn't try Xifaxan until my symtoms were pretty much gone so I can't say for sure that it was effective for me or not. But I had no side effects w/it and it felt good to know I was doing SOMETHING.
I've been on just the Imuran and Pentasa for several years now and doing well.
My computer says I need to upgrade my brain to be compatible with its new software.