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12-09-2014, 05:04 PM   #1
Lam123
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Sinus issues?

I have been taking Humira for a few years every two weeks and 2-3 times per year I get a sinus cold that goes away within a week. This summer I started humira weekly and I have a sinus cold that just won't go away, could it be tougher to get rid of because of humira? Also, how do I know if it's a possible sinus infection?
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12-10-2014, 12:19 AM   #2
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I would see an ear, nose, and throat (ENT) doctor. (Otolaryngologist)

Here are some things to consider:
+ Reoccurring sinus infections can be caused by silent reflux. I would say a lot of us Crohnies have some form of acid reflux. Info here:
http://www.webmd.com/heartburn-gerd/...-silent-reflux

My Wife who doesn't have Crohn's would get 1-2 sinus infections every year. Turns out she didn't get the hiccup type of reflux I get. It was literally unknown to her. The ENT was able to help her a lot.

+ Any time your immune system is compromised it makes it harder to fight off infections. Humira is an immuno-suppressant so it falls under this category.
http://www.rxlist.com/humira-drug.htm

+ Weather changes can also affect sinuses. Since my disease really kicked in I've noticed I'm really reactive to the weather. I have arthritis as an extra-intestinal manifestation of my Crohn's. I also have allergies. Both flare up when the weather gets suddenly warmer or colder. Most people react to temperature changes in their sinuses, but I would gather that people with Crohn's are a little more sensitive.

+ Also no matter what dose of steroids I'm on, I noticed that my nose will have blood in it when I blow it or pick at it. It's not bleeding outside of my nostrils, but I've noticed blood on the tissue. Sometimes this can be due to the steroid's effects or in perhaps a related nature, due to blood pressure spiking. When our bodies are fighting something our blood pressure can go up and cause this sort of thing.

+ If you happen to take a lot of Zyrtec for example, this can dry out your sinuses and cause cracked skin in your nostrils which could get inflamed over time.

These are some ideas, but the main point is to go see an ear, nose and throat (ENT) doctor. (Otolaryngologist) I would get a referral from your GI doctor though to help keep everyone in the loop or find an ENT who knows Crohn's.
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12-10-2014, 05:38 AM   #3
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This is why I've been dreading the GI giving me immunosuppressants. Fortunately they haven't yet. I seem to spend half my life with sinus pressure or pain as well as sort throats so the thought of taking anything that could make it worse is not a happy one.

Thanks Grace for what you said about silent reflux. I was told after my first gastroscopy that whatever it's called that's meant to stop acid coming back up was weak in my case, so perhaps that adds up. I've asked the doctor a couple of times before about my persistent sore throats, but all they ever did was swab the back of my throat and tell me there was no infection. I'd never considered it might be related to my digestive issues.
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12-10-2014, 04:09 PM   #4
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This is why I've been dreading the GI giving me immunosuppressants. Fortunately they haven't yet. I seem to spend half my life with sinus pressure or pain as well as sort throats so the thought of taking anything that could make it worse is not a happy one.

Thanks Grace for what you said about silent reflux. I was told after my first gastroscopy that whatever it's called that's meant to stop acid coming back up was weak in my case, so perhaps that adds up. I've asked the doctor a couple of times before about my persistent sore throats, but all they ever did was swab the back of my throat and tell me there was no infection. I'd never considered it might be related to my digestive issues.
It may be related, but are you in flare, as well? When my Crohn's was active, I was sick constantly -- horrible, unrelenting colds and sore throats. It actually wasn't until I went on immunosuppressants and my Crohn's went into remission that it finally stopped.
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12-10-2014, 05:56 PM   #5
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I had a flare over the summer, but seem to be back in remission now. But, I have been really run down lately, so I'm not surprised. My Dr gave me antibiotics today.
12-11-2014, 01:59 AM   #6
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DEmberton, Glad I could help. Sore throats can be a sign of acid reflux. If I eat something very acidic I can wake up with a sore throat that is not necessarily that "winter dry throat" deal. I also wouldn't necessarily hold back from immunosuppressants. They do make it harder to fight stuff, but I've also noticed my body is calmer with them and with a good hand sanitizer regimen and Lord willing I've dodged flu and cold season so far. I'd have a good talk with a good GI about what you can expect from a "cold, etc" with an immunosuppressant and combine that with what you read from others. All in all, it's your body and I'd talk to a doctor.

On the silent reflux note that's what they told my Wife - that there was a weak muscle in there that allowed it to splash back up. The ENT gave her some prescription antacids then she moved to over the counter ones. I'm on over the counter only as well.

She has this awesome natural acid remedy with raw apple cider vinegar that's pretty much eliminated her reflux and need to take antacids. I'm allergic to apples or I would try it. It's worked on both her grandfather and herself. I'll ask her what the recipe is and post it here.
12-11-2014, 06:37 AM   #7
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Thanks. Largely symptom free at the moment, though I'd noted in the past I seemed to get everything at once: stomach issues, sore throats/ sinuses as well as general aches and pains.

Drinking red wine always gives me a sore throat the next morning, so I guess that's why.

And now I think about it, the first half of this year when the Crohns was bad (before surgery) I didn't have so many sore throats. And I was getting through lots of Gaviscon, and especially before going to bed.

Tricky little disease this.
12-11-2014, 10:21 AM   #8
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So I went to the dr yesterday and have a sinus infection, I'm on antibiotics, which is causing diarrhea. But I also have a lot of stomach noises, anyone know what this could be from? Is this possibly a start of a flare? Otherwise I feel fine.
12-11-2014, 10:38 AM   #9
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Hopefully it's just from the antibiotics.
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12-11-2014, 11:11 AM   #10
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Yup - the anitibiotics could be causing that - especially if they are giving you D....
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12-11-2014, 11:58 AM   #11
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I really wish more docs had a clue, but they don't, so I will try to educate some of the patients here.

Except for some unsusual circumstances (immune suppression, prior surgery, very poorly controlled diabetes, steroid use....)

PLEASE DO NOT TAKE ANTIBIOTICS FOR SINUSITIS. Even with gunky discharge, pain in the teeth and fever, the vast majority are viral. and even the ones that are bacterial? so what? The immune system eventually gets rid of them too. Though docs are scared into thinking ealy in med school that bacterial sinus infections can spread to the central nervous system, it basically almost never happens, and certainly not in the first couple of weeks on a sinus episode. Unlike strep, which can cause problems if left untreated (Skin, heart valve, kidney) the risk of untreated bacterial sinus infections is really pretty minimal. And again, the vast majority, even the more symptomactic ones are viral.

So, again, unless it's been WEEKS of non improving symptoms, or special circumstacnes like above, NEVER take antibiotics for sinusitis. It will go away.
12-11-2014, 12:00 PM   #12
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I have been suffering with symptoms for weeks.
12-11-2014, 12:26 PM   #13
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I have been suffering with symptoms for weeks.
Causes of chronic sinus problems can include allergy, exposures (paint, carpet) lack of humidity (dry heat drying out mucous membranes,), Nasal polyps, referred pain from eye strain, tension HA.

I would rule those out, maybe even CT the sinuses before giving a patient with IBD antibiotics.
12-12-2014, 10:13 AM   #14
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Or get menthol crystals and steam the gunk out,but remember to only put one crystal in the water otherwise you look like you,ve been maced.
12-14-2014, 08:51 PM   #15
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Ok, so I have my usual sinus infection and am taking antibiotics, feeling much better but not back to normal yet. I have three more days of antibiotics, is it possible I will need another round of antibiotics? If I'm not better by the end of this round should I go back to the dr? My throat is still really hurting me.

I called my GI and he's pretty sure it's from humira, but it still outweighs the positive things humira is doing for me.
12-15-2014, 04:39 AM   #16
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I really wish more docs had a clue, but they don't, so I will try to educate some of the patients here.



Except for some unsusual circumstances (immune suppression, prior surgery, very poorly controlled diabetes, steroid use....)



PLEASE DO NOT TAKE ANTIBIOTICS FOR SINUSITIS. Even with gunky discharge, pain in the teeth and fever, the vast majority are viral. and even the ones that are bacterial? so what? The immune system eventually gets rid of them too. Though docs are scared into thinking ealy in med school that bacterial sinus infections can spread to the central nervous system, it basically almost never happens, and certainly not in the first couple of weeks on a sinus episode. Unlike strep, which can cause problems if left untreated (Skin, heart valve, kidney) the risk of untreated bacterial sinus infections is really pretty minimal. And again, the vast majority, even the more symptomactic ones are viral.



So, again, unless it's been WEEKS of non improving symptoms, or special circumstacnes like above, NEVER take antibiotics for sinusitis. It will go away.

I will have to disagree with this. Most Crohns patients are on some immunosuppressive. This lends to infections....bacterial infections. They do not go away on their own. Also some, like myself, have naturally low immunities (IGG deficiency) to fight off infection. Antibiotics are the first line of treatment in both cases. I have standing orders for antibiotics for early treatment, ie: sinus infections.


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12-15-2014, 08:45 AM   #17
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I will have to disagree with this. Most Crohns patients are on some immunosuppressive. This lends to infections....bacterial infections. They do not go away on their own. Also some, like myself, have naturally low immunities (IGG deficiency) to fight off infection. Antibiotics are the first line of treatment in both cases. I have standing orders for antibiotics for early treatment, ie: sinus infections.



If you read my first post, I said one exception was immunosuppression. However, people on a small dose of 6MP are not the same as IGG deficiency. I will certainly agree with you about IGG. However, though many people with crohn's are on meds that can make them a bit more likely to get infections, and maybe take a bit longer to fight it off, the vast majority are viral. It's all individual. I'd be more apt to treat someone on a temporary but high dose prednisone than someone on a stable small dose of 6mp for 10 years.

In GENERAL sinus infections should NOT be initially treated with antibiotics- again, save for some specific patient populations.
12-15-2014, 08:00 PM   #18
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12-15-2014, 08:23 PM   #19
baistuff
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Ok, so I have my usual sinus infection and am taking antibiotics, feeling much better but not back to normal yet. I have three more days of antibiotics, is it possible I will need another round of antibiotics? If I'm not better by the end of this round should I go back to the dr? My throat is still really hurting me.

I called my GI and he's pretty sure it's from humira, but it still outweighs the positive things humira is doing for me.

Please please please do not go on another round of antibiotics. I shudder to think what your gut flora is already like. C diff would not do you any good. Most sinus infections are viral, but even if you want to make the argument yours was bacterial, then likely it's a strep family bug. I don't know what you are taking now, but I'm guessing its strep coverage is quite good. The streptococcal family is not known for its resistance, so the chances you need a second round of antibiotics are really minimal to none. Consider seeing an ENT for continued sinus issues, rule out allergy or other exposure, or likely you just have a virus that is taking its sweet time getting out.

Agree with your GI about the Humira. You may be 100% correct it's still worth continuing. Only you can decide that.
12-15-2014, 10:07 PM   #20
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I really don't think I need more antibiotics, the sore throat started the day before I started antibiotics and hasn't gotten better since taking them. My sinus infection has been cleared up. Just not sure why the sore throat.
12-16-2014, 08:44 AM   #21
baistuff
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I really don't think I need more antibiotics, the sore throat started the day before I started antibiotics and hasn't gotten better since taking them. My sinus infection has been cleared up. Just not sure why the sore throat.
With the disclaimer that I have not examined you, I would venture to guess what you have is viral. Bacterial infections anywhere in the respiratory tract, including throat, ears, bronchial tubes and sinuses tend to just involve that one area. (i.e.- unsual for strep to cause runny nose etc...)- Not always, but in general. The fact that you have had combination symptoms- sinus, throat usually means things are viral.

Again, many docs have different approaches. Many throw antibiotics at folks. Excluding strep throat, I rarely use antibiotics for other upper tract infections. My rule (excluding immune suppresed folks) is usually 2-3 weeks, high fever, or other evidence of acute toxicity. I will also take into account very poorly controlled diabetes, smoking (for bronchitis- OK, now we are in the lower respiratory tract) as well as past history of confirmed bacterial pneumonia in someone with respiratory complaints- all of which not only make bacterial infections more likely, but also increase the chances of being unable to self clear the infection. Most healthy adults will clear even a bacterial ear or sinus infection without antibiotics. The literature backs this up.
12-17-2014, 09:58 PM   #22
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Just wanted to give an update, sinus infection is cleared up but throat and ear is still really sore. Went to doctor tonight, he did a strep test and will have results Friday. He said I'm a little swollen on the sore side and white spots aswell. Ugh!
12-18-2014, 04:34 AM   #23
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Sounds similar to what was happening to me while on Humira. I had frequent upper respiratory infections to the point where the infection lasted up until the day before my next injection. I took antibiotics often. Sometimes they helped and sometimes they didn't. Upper respiratory infections can be common with Humira and can get worse over time which may result in needing to switch to another medication.

Personally I'd try Humira again in the future if I needed to because I was on it before my tonsils were removed and I already had strep often about 6 times a year. They tend to give antibiotics to help prevent scarlet fever. Once I was off Humira I had my tonsils removed and never had strep ever again. For some people their tonsils just breed bacteria and make people sick often. Medications that lower your immune system can make these infections worse and/or make them more frequent. My Rheumatologist doesn't agree that I'd react differently to Humira but I still believe the upper respiratory infections wouldn't be as bad as they were back when I had my tonsils which were already making me sick often before I started taking it.
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12-18-2014, 02:40 PM   #24
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Thanks for the info,Jennifer. My throat feels a bit better today, but I find since I started humira weekly, sinus issues worse.
12-18-2014, 04:19 PM   #25
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I'd be more apt to treat someone on a temporary but high dose prednisone than someone on a stable small dose of 6mp for 10 years.
For Crohn's?

"In general, I try to minimize (or avoid altogether) the use of systemic steroids (i.e. prednisone) in Crohn’s patients if at all possible. This is based on current guidelines, clinical observations and teaching I received during my inflammatory bowel training at Mount Sinai. There are many reasons for this approach. The first is that, while steroids can lead to short-term disease improvement, they do not appear to be able to fully heal intestinal tissue over time (also known as mucosal healing). The ability of a Crohn’s medication to achieve mucosal healing is being increasingly recognized as an important treatment goal.

In contrast, other therapies such as azathioprine, mercaptopurine and biologics have been shown to accomplish this objective..."
http://www.crohnsforum.com/showthread.php?t=50497

In GENERAL sinus infections should NOT be initially treated with antibiotics- again, save for some specific patient populations.
Like the majority of this forum. This forum is full of members who are immune compromised. Yes antibiotics are overused for the general public but we're not the general public.
12-18-2014, 05:34 PM   #26
baistuff
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For Crohn's?

"In general, I try to minimize (or avoid altogether) the use of systemic steroids (i.e. prednisone) in Crohn’s patients if at all possible. This is based on current guidelines, clinical observations and teaching I received during my inflammatory bowel training at Mount Sinai. There are many reasons for this approach. The first is that, while steroids can lead to short-term disease improvement, they do not appear to be able to fully heal intestinal tissue over time (also known as mucosal healing). The ability of a Crohn’s medication to achieve mucosal healing is being increasingly recognized as an important treatment goal.

In contrast, other therapies such as azathioprine, mercaptopurine and biologics have been shown to accomplish this objective..."
http://www.crohnsforum.com/showthread.php?t=50497


Complete miss of the point I was talking about. More "apt" meant to treat someone who has an infection with antibiotics- meaning high dose steroids (and even lower dose) are much more likely to immunue suppressed acutely than someone on a small stable dose of 6mp for many years. Their system adapts over time, and though true, may not have the same immunity as a completely healthy person, is really not all that severely immune suppressed- especially compared to someone on steroids.

Steroids, though of course necessary at times, have one of the most horrible short (immune supression, insomnia, anxiety) and long (osteoporosis, diabetes, cataracts) side effect profiles of any medication on earth. Avoid them as much as possible. Sorry if the above statement was not clear, but we were talking about appropriateness of treating infections with antibiotics, NOT treatment of crohns.


Like the majority of this forum. This forum is full of members who are immune compromised. Yes antibiotics are overused for the general public but we're not the general public.

I think you are jumping to often jumped to conclusion that is not always 100%accurate. Here is the teaching point- Not every person on a drug that can suppress the immune system is FUNCTIONALLY immunosuppressed. People on these meds who get infections ABSOLUTELY need to be evaluated and docs and patients need to be on high alert for bacterial infections, but the vast majority of cases are still viral, and many have systems that can still easily fight these off. All I am saying is that I am of the opinion that knee jerk antibiotic treatment is not smart medicine. You have every right to disagree.
12-18-2014, 05:35 PM   #27
baistuff
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"In general, I try to minimize (or avoid altogether) the use of systemic steroids (i.e. prednisone) in Crohn’s patients if at all possible. This is based on current guidelines, clinical observations and teaching I received during my inflammatory bowel training at Mount Sinai. There are many reasons for this approach. The first is that, while steroids can lead to short-term disease improvement, they do not appear to be able to fully heal intestinal tissue over time (also known as mucosal healing). The ability of a Crohn’s medication to achieve mucosal healing is being increasingly recognized as an important treatment goal.

In contrast, other therapies such as azathioprine, mercaptopurine and biologics have been shown to accomplish this objective..."
http://www.crohnsforum.com/showthread.php?t=50497


******Complete miss of the point I was talking about. More "apt" meant to treat someone who has an infection with antibiotics- meaning high dose steroids (and even lower dose) are much more likely to immunue suppressed acutely than someone on a small stable dose of 6mp for many years. Their system adapts over time, and though true, may not have the same immunity as a completely healthy person, is really not all that severely immune suppressed- especially compared to someone on steroids.

Steroids, though of course necessary at times, have one of the most horrible short (immune supression, insomnia, anxiety) and long (osteoporosis, diabetes, cataracts) side effect profiles of any medication on earth. Avoid them as much as possible. Sorry if the above statement was not clear, but we were talking about appropriateness of treating infections with antibiotics, NOT treatment of crohns.
12-18-2014, 07:12 PM   #28
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Sorry ya the last statement wasn't clear, thanks for clarifying.

As for antibiotics yes they are overused. It's best to make sure that you do in fact have a bacterial infection before treating with antibiotics (unless it's urgent and you have a history of frequent bacterial infections). Antibiotics won't do anything if it's viral. So I'm not disagreeing with you on that at all. Many doctors prescribe them just in case it's bacterial and because it takes a while for tests to come back yet I also think they do take into account their patient's history. I don't think we disagree at all, just a misunderstanding.
12-18-2014, 08:38 PM   #29
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Another issue with sinusitis that makes a difference (just as a side note) is other underlying conditions. I am generally treated with antibiotics if the doc is at least reasonably certain its bacterial, partially because i am now taking aza, pred, and humira, but also because im an asthmatic ... thats another population that must be carefully managed
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12-18-2014, 08:50 PM   #30
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Another issue with sinusitis that makes a difference (just as a side note) is other underlying conditions. I am generally treated with antibiotics if the doc is at least reasonably certain its bacterial, partially because i am now taking aza, pred, and humira, but also because im an asthmatic ... thats another population that must be carefully managed
Agree. Asthmatics can trap organisms, but still would not always knee jerk give them.
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