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Taking humira with an active fistula?

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Crohn's Disease
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Posted 12/27/2017 2:39 PM (GMT 0)
Until recently I thought I had Ulcerative Colitis but after getting a huge perianal abscess, a lot of my doctors began to think it was actually Crohn's. I've had UC for about 15 years now with most of my major flares occurring in the past seven years.

Anyway, I've been on Humira for a number of years as well and some doctors have said that taking my Humira injection was the reason my abscess came back a few days after having it lanced. I took Humira, then the abscess began to increase in size over the next few days to the point where I had to have a huge incision so it could be drained.

It was healing nicely until a few days ago, I could feel something hard growing underneath the healing wound. I thought it was scar tissue or something until it burst on Christmas day, forcing me to go into the ER to have it cleaned up. They made a small 1cm incision so that it could keep draining but that incision is closing quickly and should be closed soon.

Now it's Dec. 27th and I'm a day late for my Humira injection, and I'd like to call my specialist(s) to ask for their opinion but all of them are on vacation until the middle of January. I also don't have a family doctor yet as I just moved to a new area in Canada.

The fistula drained itself and there's still a bit of drainage but I have no fever or anything like that. My instructions were not to take Humira if there are any signs of infection, and I don't know whether a bit of drainage is considered a sign of infection. I'd love to ask a professional, but it's literally impossible to even ask this time of year.

Should I take the next Humira or should I keep holding off? Thanks.
Posted 12/27/2017 5:24 PM (GMT 0)
Hi WaveFunction, abscesses can be very painful & nasty to deal with. If possible go get yourself a sitz bath & soak this to keep it open & draining. If this is not doable get in a tub full of the warmest water you can & soak. Are you running a temperature? Did ER put you on any antibiotics? If you are not running a temp, I say take your Humira. People with fistulas & abscesses use bio's all of the time.

I had a fistula & was on Remicade which healed it. Depending on the length of time you have been dealing with this, it may be time to talk about Remicade or one like it. I am not sure of the success rate of Humira healing this. Perhaps one of the other members can give input on how well Humira works with this problem.

I am not a dr, but if you are not running a temperature I think you should be fine. I wouldn't hesitate to stay on schedule. Yes, there is a potential of the immune system being compromised, however, while on bios I had no issues. I was healthier when I look back & I think it was because the medication was doing its job.

Take care.
Posted 12/27/2017 9:25 PM (GMT 0)
I was on humira while having a fistula that would abscess. the fistula healed while I was on (and because I was on it) humira. As straydog says, you should be okay if you don't have a fever, though you would be much better off seeking medical help. Doesn't your doc have an emergency on call doctor or line that you can reach someone for questions?
The cons of skipping doses of Humira mean that it could significantly lower its effectiveness. there was a study out recently that delaying doses could make a big difference (https://www.nature.com/articles/ajg2017438 )
and that could negatively impact the fistula as well.
Posted 12/27/2017 9:51 PM (GMT 0)
Thanks for the replies. I ended up taking it, for most of the reasons above. I didn't want the Humira to lose its effectiveness and I wanted to nip this fistula in the bud any way I could.

As for contacting the hospital, I tried contacting my GI doctor as well as the specialist who worked on my abscess before and everyone's off for the holidays. Even the referral numbers went straight to a voicemail saying everyone was on holidays until Jan 10th or later. I did get through to the 24/7 nursing line they have here in Ontario, and the nurse there basically said a lot of what was said in this thread and left the choice up to me.

Anyway, so far so good. I just wish the doctors were more consistent. I hesitated because when I had the original abscess removed, some were adamant that I should take Humira and others were adamant that I shouldn't. It's also possible that the first abscess became the second abscess because I took Humira afterwards, further complicating things.

The funny thing is that I've never even been diagnosed with Crohn's. I've only ever been diagnosed with UC and that diagnosis has been made in three separate countries (I lived in Asia for ten years). Now they're saying that UC and Crohn's is a spectrum and I'm closer to the middle. Some doctors also assume it's Crohn's, full stop.

/rant
Posted 12/27/2017 11:48 PM (GMT 0)
Yes, that was a fear I had when I started humira with the fistula active. Luckily nothing went wrong. Localized infections aren't as big of a problem as more systemic ones. Also fistulas can be draining and inflamed but not be infected but your still at higher risk of getting major ones. look out for chills and body aches, they can also be a sign of infections even without fever.
I know the whole situation can be very confusing and that is really not right that they don't have at least one Doc on call during the holidays.
Posted 12/28/2017 8:14 PM (GMT 0)
Turns out it wasn't a fistula after all! I'm new to all of this so I just assumed it was, but the nurse at the clinic I go to said it was just another small abscess in the same area, which is a far better outcome. We're packing it again and letting it drain until the original wound closes.

I guess if it were a fistula, it would've had an odor (which it didn't) and it wouldn't have drained from the same hole my original abscess drained through. Here's hoping I never get a fistula, though they did tell me I had a 70% chance of getting one.
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