Recommended Azathioprine but have foreseeable problems

Hi I am new here and looking for some advice. I am 56 and was born with Crohn's Disease. I have had 2 ops and have been taking Prednisolone all my life to control flairs.

However I recently had a really bad flair that landed me in hospital where I was told the Crohn's had spread and is in end stage.

I have been recommended Aza which I have refused in the past because of fear of bacterial infection. This wouldn't be as much of a problem except that I am intolerant of all the antibiotics I have tried so I fear they wouldn't be able to treat the problems associated with taking an immuno-suppressant.

Additionally because I have crohn's since birth I am only 4' 9" and weigh 7 stone so I am worried about doses being too large.

Is there any advice or recommendations you could give me.

Personally I have always been more scared about pred than aza. I have been on aza for many years without any side effects. In terms of infections, I rarely get sick (I haven't had a common cold or other infection in 2 years), although paradoxly before starting aza I usually had common virus or other infections regularly like most other people.

I would not worry too much about the right dosage. You start with a low enough dosage and increase it as necessary. Early on you have weekly or biweekly blood tests to see where your white blood cell count is (and to check other complications), so you and your GI can fine tune your dosage. You aim to have your white blood cell count in your lower normal range between 4 and 5 or slighlty below 4 but not significantly below 4 (should not go below 3.5). There is a sub forum on aza, by thr way http://www.crohnsforum.com/forumdisplay.php?f=64

Just wondering, with Crohn's being in the "end stage" you mean it has spread to your lower smaller intestine?

As you had Crohn's for many years and had a pretty bad flare recently, I would talk about biologics treatment with your GI. Biologics like humira are, after all, statistically more effective than immunosuppressives. I'd just talk about pros and cons before going for aza right away.

Hi alex_chris. Thank you very much for responding. Its great to hear about people on Aza not experiencing no bad side effects.

My crohn's has spread right through my small and large bowel. I have been reading the Aza sub forum you linked and have found a lot of interesting information.

I am going to see the consultant in 6 weeks and am going to ask him about Humira and whether it might be another option.