Questions Answered By Expert
Sasha Taleban, MD
Arizona Health Sciences Center, Assistant Professor of Medicine, Director of IBD Program
A: Thanks for your question. Several medications can cause hives. However, it would be unusual that your son having being on 6-MP for several years would then go on to develop hives. It was completely appropriate to seek out a health care professional for the symptoms, but since there are multiple causes of hives besides medication, it may be best to await the work-up before attributing the symptoms to 6-MP. hide answer
A: This is a great question. When it’s time to advance medical therapy to medications like azathioprine (Imuran) and infliximab (Remicade), there are multiple considerations. There is data that both medications are effective in CD. The better choice is going to depend on the specific patient. Azathioprine takes 2-3 months to generally kick in and is an oral medication taken daily while infliximab can kick in after 2-4 weeks but is given as an IV in set intervals. It will be best to discuss the best choice with your gastroenterologist. hide answer
A: This is a very common question. The two most common types of cancer associated with azathioprine are: 1) nonmelanoma skin cancer, and 2) non-Hodgkin’s lymphoma. The risk of skin cancer is about twice that of those individuals with ulcerative colitis who are not on azathioprine. This risk goes away once the medication is no longer being used. Non-Hodgkin’s lymphoma is much less common, and is about four times as likely with azathioprine than without it. However, this risk still equates to about 1 in 1000 after years of taking the medication. Again, once the medication is no longer used, the risk appears to go away. For both types of cancers, older patients (>60 years old) have the highest risk. Having said this, we also have to weigh the risks of any medications against the risks of having uncontrolled ulcerative colitis like surgery and colon cancer. I’m glad to hear your disease is under control. hide answer
A: Good question. Crohn’s disease can be associated with gum disease. Gum disease would not be a common association with Humira. With regards to skin abscesses, if you’re referring to abscesses around the anal region, then Crohn’s disease (but not Humira) can definitely be associated with this. As far as skin abscesses on other parts of the body, this can occur with immune suppression of any kind including Humira. If your gastroenterologist has not evaluated the skin sores already, it would be a good idea to speak to him/her. hide answer
A: Crohn’s disease, either directly or indirectly can cause oral sores. Oral sores are rather common, present in 20-50% of Crohn’s disease patients. The sores are generally just breaks in the lining of the mouth that result in an ulcer. Since Crohn’s disease can affect any part of the gastrointestinal tract from your mouth to the anus, these sores may be a result of the disease. Crohn’s disease can also result in nutritional deficiencies (i.e., folic acid and other B vitamins) that can make a patient more prone to mouth sores. Additionally, methotrexate, a medication used in Crohn’s disease, is a common culprit for mouth sores. Generally, if the sores are from Crohn’s, treatment of the Crohn’s itself can causing healing of the ulcers. If you’re taking methotrexate, you can increase the amount of folic acid taken on the day of the methotrexate itself (to say 5 pills that day). If neither of these are the issue, your doctor can evaluate for nutritional deficiencies that may be playing a role. hide answer