The Rhemuy said he would treat it as a flare up and take a conservative route. Start IV steroids and bridge to Methotrexate while weaning me of Imuran. Long term he hopes Methotrexate will hold the extra intestinal stuff and that Vedo will quieten the bowel (I've been on Vedo for a year with good bowel results). Failing that he would consider using a biologic that would treat gut, joints and eyes together. Failing that he even considered dual biologics as a possibility.
In a way I'm sad to come off Imuran. Clearly it worked to shut down bowel and joints in 2013 and held the joints until 2019. However he thinks Mtx works better for inflammatory arthritis than Imuran.
He cannot name what the inflammatory arthritis is and may never be able to do that as it shows no unique identifiers. At the moment he considers it linked to a bowl pathlogy and that in 30% of cases a joint, skin, and eye flare up can occur without active bowel inflammation.
However, he does mention that it could still be in the 70% case and that even though scopes are clear there is the possibility that I have active inflammation in the small intestine of a Crohns nature that is producing no bowel symptoms at the moment. My colonscopy and CT scan are clear but I do have a lot of bloating and have always wondered about
some form of ileitis or non inflammatory stricture. I had "patchy inflammation" and "ileitis backwash" in 2013. The latter was linked to pancolitis and the patchiness was linked to the bowel healing in a non-uniform way and so explaining the lack of continuity that should be seen as part of my UC dx.
Further advice / opinion greatly appreciated.
Post Edited (Charlie789) : 9/29/2022 1:17:38 PM (GMT-7)