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← Return to Prednisone to Kevzara back to Prednisone. ( Hope not )
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Prednisone to Kevzara back to Prednisone. ( Hope not )
Polymyalgia Rheumatica (PMR) | Last Active: Oct 8 2:17am | Replies (67)Comment receiving replies
@grumpa
I don't think my rheumatologist would have ever started me on Actemra with a history of Crohns. I was led to believe that Actemra and Kevlara are prohibitive for anyone with inflammatory bowel disease (IBD).
Ever since I was diagnosed with reactive arthritis in the early 1990's, I have always been afraid of developing IBD. It was an enteric infection that ushered in a slew of problems for me.
I had my first colonoscopy that was ordered by a rheumatologist who wanted to see if I also had Crohns back in 2008. When PMR was subsequently diagnosed, I was started on long term Prednisone. I felt vindicated because I was treating myself with many short term bursts of high dose Prednisone for 15 years before PMR was diagnosed.
Crohn's and Reactive Arthritis are in the same spectrum of disorders. I remember when I was first diagnosed with reactive arthritis with uveitis in the early 1990's. The primary care doctor that diagnosed me with Reactive Arthritis mentioned HLA-B27 but didn't want to do the test to see if I was positive or not. The only reason for not doing the test was that it wouldn't change my diagnosis or anything about how I would be treated in the future.
I was tested for HLA-B27 because I was curious and said it would be nice to know. I was positive for HLA-B27 and now my medical record is full of references to HLA-B27 associated things.
https://www.ncbi.nlm.nih.gov/books/NBK551523/
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HLA-B27 is a gene that plays a role in the immune system. It is associated with an increased risk of developing certain autoimmune diseases, including Crohn's disease.
I used to be active on forums for spondyloarthritis. There were people with Crohn's on those forums. Everyone it seemed was being treated with various biologic treatments. I left the spodyloarthritis forums because nobody was being treated with long term Prednisone like I was. In fairness, they all had their various specialty doctors and I was treating myself with Prednisone until PMR was diagnosed many years later. That was when I got the attention of several specialists but never a gastroenterologist.
Replies to "@grumpa I don't think my rheumatologist would have ever started me on Actemra with a history..."
There is nothing on the Kevzara website referencing not to take if a Crohn’s patient. There are many biologics that are approved for Crohn’s. Most come with their own similar warnings like Kevzara and Actamara. Personally I am glad to be back on prednisone I’ve never had the issues with infections while on prednisone. We can be so different with our reactions to medications. I’m highly allergic azathyaprine (Imuran) a dmard, but I was on Methotrexate , a different dmarad a few years.
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I just remembered ... it was another enteric infection that triggered the multiple, bilateral, and extensive pulmonary embolism (PE) that I had. The intensive care doctors were inclined to suggest that Prednisone contributed to the event but called the PE unprovoked.
My primary care doctor apologized for possibly missing something. I told him about the enteric infection before the PE. He said people have enteric infections all the time and don't have a PE like I had.
I told my primary care doctor there was no need to apologize. I was the one who refused the pulmonary function test that he recommended when I was complaining about being short of breath with exercise intolerance about 6 months before the PE happened. My primary care doctor said the report he got from the intensive care unit said I had an "acute PE" so I wasn't having chronic PE's.
Now that I'm off Prednisone my medical history seems boring now compared to when I was taking Prednisone. The sequence of events leading to the PE suggests a complex interplay between an underlying inflammatory process being managed with Prednisone combined with an infection.