What Causes Fatigue And Joint Pain When Diagnosed With Crohn's Disease?

Posted on Fri, 17 Jun 2016

Question: I am 48 years old and have Crohn's disease. 18 years ago I was diagnosed with UC. I was put on several different medications including large doses of Prednisone but nothing worked. My colon was removed and I have a J-pouch. (As an aside, the pathology following surgery showed that I was in early stages colon cancer.) A few years later I had my thyroid removed and then 9 years ago I was diagnosed with Crohn's. I was on Entocort EC for most of that time. However, I had a severe flare-up in January and was hospitalized almost 3 weeks. In addition I had an obstruction and was headed into surgery when it cleared so no surgery. However, my pain continued and got worse. I then contracted C.diff in the hospital and was treated for that. Yet, the pain continued. As a last resort before exploratory surgery, my doctor started me on Humira and my Crohn's (stomach pain) is much better. While in the hospital they also gave me Prednisone which I just tapered off of a few weeks ago. However, since being released from the hostpial mid-February, I have been extremely fatigued and am having a lot of joint pain. At first I thought my fatigue was from the illness and hospitalization or from coming off the Prednisone but it seems not to be getting any better, if anything it's worse. Could the fatigue and joint pain be side effects of the Crohn's, the Humira or something else? I know Humira is used to treat RA so I would think that joint pain would be better. Also, my PCP started me on B-12 injections this week (once a week for 2 months then monthly). He also wants to reduce my synthroid from 175 a day to 150 a day. I don't think I should because I have never had to decrease per my endocrinologist in the last 10 years since having my thyroidectomy. Thank you for any advice!!

Answered by Dr. Abhijit Sonawane (15 hours later)

Brief Answer:
check thyroid functions first

Detailed Answer:
Hello,
Thanks for posting in HCM.
I went through your query and understood your problem.
Humira is a monoclonal antibody, a type of immunosuppressive agent which have reduced the immunological response given by your body to the chrons. Hence you are feeling better with that.
Though it is used against RA, it does not reduce the pain in RA. It again reduces the response and hence gives pain relief.
Joint pain and fatigue are well known other manifestations of chrons disease. The treatment for this is to treat the chrons, other effects will automatically go away. So it comes alongwith chrons.
It also might be possible that you can have anemia which is causing this fatigue. So checking you hemoglobin will help to confirm the diagnosis and help in treatment.
Also its good that you are taking vit B12 injections as it tends to decrease in chrons.
About the thyroxine, its better first to check your thyroid profile and see whether this dose is optimal for you or more. If its more then we need to reduce the dosage or you will go in hyperthyroidism.
So my advise will be as follows-
1. Get a complete blood picture done which will include Hb and other parameters.
2. Check your thyroid profile- T3 T4 and TSH. Depending upon the report decide whether synthyroid should be reduced or not.
4. Joint pain and fatigue will go away as you recover from chrons slowly. Meanwhile consult an orthopedic surgeon to rule out other causes of joint pains like osteoporosis or ankylosing spondilytis.
5. If the pain is troublesome then you can take some analgesics like paracetamol or tramadol can be taken.
I hope I have answered your query well.
If you have any questions kindly ask me back.
Thank you

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Above answer was peer-reviewed by : Dr. Prasad