Mercaptopurine or Remicade

New to the Forum seeking experience.
Hello, I just got back from my colonoscopy and it turns out I was so inflamed that my Doc didn't feel comfortable going all the way around my colon for fear of perforation.
I am at a crossroads, and do not know what to do. Diagnosed at 12yo I have bleed intermittently from colitis. For the last year I have bleed intermittently with bowel incontinence chronically. I also have had bilateral knee and muscle pain that has altered my lifestyle significantly. MRI's of knees are normal. My Rhum MD ruled out any other autoimmune disease and states its related to UC.

Current drugs are asacol HD, just stopped prednisone burst, rowosa and steroid enema, and Metamucil. My gastro MD wants me to take mercaptopurine. My Rhum feels like remicade is the better option to treat the UC and the arthralgia. My arthralgia treatments have included Tylenol, motrin(made me bleed), meloxicam(made me bleed), Voltoran gel, extensive physical therapy, acupuncture. My questions and concerns.

Mercaptopurine I am concerned may damage my liver and kidneys, also my Rhum states I will not help my joints. (I do not have RA). I am also worried that if it does not work and I have to then do remicade then I may be at risk for cancers per the documented research.

Remicade- I am concerned that this may be a lifelong drug if I start it. I worry about cancer. I worry that you cannot stop and restart the drug as you may create antibodies to the drug. I am concerned about side effects. This drug may help my arthritis pain.

Any insight may be helpful. I feel up against a wall here...my doc has also said that she would refer me to a surgery if I wanted, but I don't think I'm even close to that...but it makes me think I'm bad enough for her to be concerned.
about me: I'm a very active 28yo RN and volunteer fireman who is off the engine right now because I have too much pain. Thanks.

There is an extra-intestinal manifestation of an IBD called Peripheral arthritis. This is a non-damaging form of arthritis that is closely linked to the inflammation in your colon. The colon inflames and so do the joints. It is not detected on MRI's or x-rays. I also have this and was diagnosed by a Rheumatologist.

I was originally on 6mp (for about 6 years) and even tho it helped control some of my joint pain as well as my UC. I was still mildly flaring with UC the entire time. 6mp can work for many people but like stated it can take a few months to achieve remission (if it works).

Once I started on Remicade, both my UC and joint pains went into remission.

So basically, it's a toss up. 6mp or Imuran can work very well or it doesn't. Honestly, if I was you, I would try the 6mp or Imuran before Remicade because Remicade is one of the last line of defenses against UC.

But the choice is yours.

I can honestly say that I don't like either drug. 6mp caused me major fatigue, caused me to bruise easily and even tho I never got sick easily, but when I did I got SICK.

Remicade doesn't cause me to bruise but I'm more prone to opportunistic infections such as chronic UTI's (however I do have a history of this even before Remi), sinus infections and I just got over a bout of strep throat. And as I am typing this I am fighting yet ANOTHER bout of a UTI.

However, I will gladly take these minor nuisances over the gut wrenching pain of UC any day.

If you're that inflamed that you couldn't get scoped, you may do best with remicide since it works quickly. It's also great that it can kill two birds with one stone.

It would be great if you could opt for neither but it sounds like you're suffering so some kind of plan will hAve to come into play.

Have you been checked for c diff? They should rule out bacteria before jumping the gun on medicines. I also hate that these meds can be lifelong which forces us to always be insured well which usually means group insurance through an employer. So frustrating. I can understand not wanting to get looped into that kind of thing.

I'd go with Remicade because it sounds like your UC is quite bad at the moment, and Remicade will act more quickly. Also, I think that it's more likely your joint pain will be controlled with Remicade.