Questions Answered By Expert
Heba Iskandar, MD, MSc
Associate Professor, Director of IBD Clinical Research
A: I agree with advancing treatment to biologics or immunomodulators if there are active symptoms despite mesalamine, but I encourage you to a. Verify objective active inflammation with stool calprotectin and/or flexible sigmoidoscopy. b. Have a comprehensive discussion of ALL your medication options (what you listed are only a couple of options - besides azathioprine/adalimumab examples of other options are infliximab, vedolizumab, and ustekinumab). c. come to a shared - decision with your doctor about the best treatment for your UC. hide answer
A: Yes , this is entirely possible and skin reactions can occur at any time after starting a medication. Humira can cause certain kinds of psoriasis, hives, and lip swelling in some cases. In your situation, I recommend consulting with a dermatologist, possibly an allergist, as well as your GI to determine the best course of action moving forward. hide answer
A: With full mucosal healing in the rectum and no urgency, bleeding or perianal fistulas or fissures, sexual activity is possible. I recommend discussing your sexual health as a goal of your treatment with your gastroenterologist and continuing to adjust your treatment to achieve healing of your colon. Also, getting appropriate psychological counseling is a great addition to your care. hide answer
A: Budesonide is a very effective treatment for microscopic colitis. Microscopic colitis has 2 subtypes, collagenous and lymphocytic colitis. Yes, this is a type of inflammatory bowel disease but generally has a good prognosis in that it does not increase colon cancer risk like ulcerative colitis can. The cause of microscopic colitis is unknown, but the immune system is definitely involved ast is is an inflammatory condition. Some microscopic colitis can be triggered by certain medications (like NSAIDS, acid suppressants, antidepressants), so I recommend a thorough review of your medication list with your GI physician. Budesonide is the most effective treatment for microscopic colitis, even though it can also be treated with cholestyramine and bismuth. If there is no response to budesonide, other conditions/problems should be considered and a work-up for other causes such as food intolerances and celiac disease initiated. For certain refractory cases of microscopic colitis, the use of medications normally used for Crohn’s and ulcerative colitis like biologic therapies and immunomodulators may be needed. Some resources for reading: https://gastro.org/guidelines/liver-diseases/the-medical-management-of-microscopic-colitis/ https://www.mayoclinic.org/diseases-conditions/microscopic-colitis/diagnosis-treatment/drc-20351483 hide answer
A: Rectal bleeding and burning in the abdomen are not side effects of the medication humira itself, however, they could be a flare of Crohn’s disease itself or a complication of Crohn’s (such as a stricture, partial bowel obstruction, abscess). The symptoms need to be evaluated with endoscopy/colonoscopy or imaging studies. They could mean that the humira is not working well for your Crohn’s or that your medication or treatment needs to be adjusted. hide answer