Don't people usually try immunosuppressants like 6mp first?
You can certainly ask about
them. A low dose might work for mild inflammation.
More and more gasteroenteroligists are skipping right over immunosuppressants and going right to biologics. Biologics work much quicker, don't require frequent blood monitoring, and don't have the longterm lymphoma/skin cancer risks. Often when you do go on immunosuppressants, the doctor only wants you on them for 2 years and then gets you off.
Also, just wondering if it seems like people with more severe disease activity within the first year of being diagnosed seem more likely to need surgery?
UC prognosis can be wildly unpredictable, especially within the first 5 years since diagnosis. Just because our UC gets worse (a Common thing within the first 5 years) doesn't mean we will need a surgery. Being in a sustained deep/quinescent/histological remission are your best guards against needing a surgery. So, you want to find your solution that works long term and stick with it. If you've been hospitalized due to your UC, have severe pancolitis, and/or are refractory (non-responsive) to all three classes of UC drugs then you have higher odds.
I'm already looking at starting biologics which from what I understand are the last line of medication before surgery.
A lot of doctors are doing the top-down-approach. They start with the stronger medications earlier on, to try and give us the best quality-of-life and catch UC before it progresses and spreads for the best management of UC. So, trying biologics doesn't mean you are out of options (unless you've tried everything including immunomodulators and other things). In the end, your UC can either be controlled or it cannot, why delay the inevitable? You can limp by for 5 years and be miserable while you save the big guns for absolute last resort. Or you can try them early and control your UC before it develops into a true monster.
Moderator Ulcerative Colitis
John, 39, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasaU.C. = Unimaginable Crapnado