Questions Answered By Expert
Christina Ha, MD
Director of the Inflammatory Bowel Disease fellowship at Cedars-Sinai Medical Center, Associate Professor
A: These symptoms can be related to either continued Crohn’s disease activity, medication related adverse effects or infections. Please discuss these symptoms, especially if new since starting certolizumab pegol (Cimzia) and have a plan to assess response or non-response to the agent within 8-12 weeks of starting treatment. If you are unable to taper off prednisone or do not see notable improvements, then you and your provider should re-evaluate to see if this is the right medication and the right dosing at the right interval. If you are having any adverse reactions to the medications, then your provider also needs to be aware. hide answer
A: This is certainly an area of interest and need for further investigation. The best studies evaluated the effects of cannabis for Crohn’s disease and did not show consistent meaningful results. We do know that certain symptoms of nausea, decreased appetite, potential fatigue/pain may be improved with cannabis, but there isn’t enough evidence-based data to support the use of CBD oil as a primary treatment for ulcerative colitis. hide answer
A: Unfortunately, the data for using ustekinumab (Stelara) for Crohn’s disease is based on dosing every 8 weeks. Extending the interval longer in between injections increases your risk for loss of response, flares and potentially forming antibodies. You should discuss options to help with the costs of obtaining the ustekinumab (Stelara). There are patient assistance and savings programs that may offset some of the costs of the medication. hide answer
A: Great question – absolutely, we recommend continuing with the infusions throughout all three trimesters of pregnancy as the priority is to keep your daughter (the mother) in the best health possible to insure a safe and health pregnancy. Infliximab, and all the anti-TNFs, are safe to continue throughout pregnancy and safe to use during breastfeed as very little is passed into the breastmilk. Because these agents are proteins, any tiny amount ingested by the baby will likely be degraded by digestive enzymes. While most of the agents cross the placenta and can be present in the baby’s bloodstream at birth, there have so far been no increased safety signals in terms of infections, developmental delays, or growth retardation. We know this thanks to the PIANO registry, a multicenter prospective pregnancy outcomes registry run by Dr. Uma Mahadevan of UCSF and funded through the Crohn’s and Colitis Foundation. It’s important to discuss family planning with your provider and a high-risk obstetrician familiar with IBD. Moderated Note Added: To learn more about the PIANO Registry email info@crohnscolitisfoundation.org or view program transcript at: http://www.slideshare.net/CrohnsColitis/facebook-chat-120-pregnancy-in-ibd-and-neonatal-outcomes hide answer
A: The most common cause would be a hernia from a prior incision site, but that’s usually evident on physical exam particularly if it bulges out as you move from laying down on your back to sitting, for example. Most hernias don’t require intervention, they also may or may not be seen on imaging studies depending on size and location. If it’s not a hernia, then I would ask your provider about other possibilities. Concerning features would be increasing size, pain, warmth to touch, redness, fixed position – not mobile. hide answer