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Signs of Remission?

So Mallory has been on prednisone for 3 weeks since her diagnosis of Crohns. We have noticed an increase in activity but more like limited hyperactivity then the energy dies. She did not present with typical symptoms as she has more external manifistations: headache, fever, intermittent hip pain, lethargy, racing heart, weightloss. She's always had her appetite but just not maintaining the nutrition. Since being on meds, she has gained about 4lbs. Her fever is pretty much gone but she is still having a fair amount of headaches. The hip pain has gotten worse & constant (talked about it on another post).

Went to GI and Rheumy appt today. Quick look over and happy with weight gain, not so much about hip pain. He is suggesting weening on prednisone and starting 6MP for overlap. We need to schedule MRE and we did have a ton of bloodwork done. They don't want to do a CT due to the radiation and her age. Her numbers are coming down but are still very high. Sed rate of 53 was 93. CRP of 3 was 7. Platelets are still high at 674 and her white blood cell count is going up to being close to above high normal range. My big question is neutrophil % since I know you guys are awesome at test values. It is 91% of her WBC (If I understand it correctly). I'm assuming by test numbers that she is not in remission and I'm hoping this tapering of prednisone starting tomorrow is not going to backfire. They are hoping her tests might show if she is working on an abscess or fistula but is there a way to tell? She's also got a little bit of wonky stuff going on with her thyroid & kidneys they think...something about osmalality?

Rheumy gave us some stretches in hopes of helping the hip but they also think that it is not joint related...one says see the other about the issue. I guess I was hoping the concept of a worsening hip would be a bit more alarming but I guess we shall see what they think in the am when they see her work. I really ought to not by on MyChart looking at her results and Googling :)
 

DustyKat

Super Moderator
Prednisone can falsely increase a WCC but in view of her other values I wouldn't say this is the cause.

The increasing WCC, increased neutrophils, high platelet count and raised inflammatory markers it certainly seems to be indicating that some sort of infective/inflammatory process is still going on. I think it would be these tests that they are are looking to for those reasons.

Good luck! Keep us posted on how you get on!

Dusty. xxx
 
Thanks Dusty. I sent an email this morning asking them their thoughts on her bloodwork. I'm not surprised that she still has inflammation going on as we are on week 3 of prednisone but I'm more concerned about an infection somewhere like in the ileum. She has that constant, worsening pain in the right hip. Rheumy said that it is not arthritis and more than likely something in the gut and a bit of referred pain. Didn't Matt have something like this sort of happen. We've got an MRE scheduled for this Wednesday so I am hoping that this would show one if there is an infection in there.
 

DustyKat

Super Moderator
Yes, he developed pain that went from around his navel and down toward his right hip. He always described the pain as tightness and burning. He also developed a limp, some days I could detect it and other days not. When the pain was severe he could barely put any wight on his right leg at all and that was what sent us to the ER. At that point his bloods, CRP & WCC, were through the roof but up until then they weren't normal but nothing worrying either. He was also on Imuran so that coupled with the Prednisone probably did a good job of masking some things like a fever. It ended up he had a psoas abscess and fistula. Just be aware that if the MRI is normal for these things, but she has inflammation present and her symptoms persist, the inflammation may be hiding the fact that they are there. Just something to think about.

Dusty. xxx
 
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