Have you tried traditional UC meds delivered directly to the rectal cuff, such as Canasa suppositories?

Also, FWIW, long term prednisone would concern me more than long term methotrexate.

Canasa and/or hydrocortisone suppisitories are treatments for cuffitis. Did you ever have pouchitis? The Flagyl your rheumy suggested is used to treat it. It sounds like you should have a pouch scope.

I have Enteropathic Arthritis related to having UC.  My rheumy put me on Sulfasalazine.  It's usually the step before methotrexate.

Prednisone and MTX seems reasonable, but the prednisone should only be short term. Also, I agree that sulfasalazine is the more typical first step, unless you are allergic to sulfa. 

For my enteropathic arthritis, my rheumy started me on biologics before an immune modulator. It was not until I developed chronic pouchitis that Imuran (azathioprine) was added.

Jan

THanks all, Yes have tried canasa for two weeks with no improvement. Just doing 1-2wks pred. for some relief. I have a lot of output from this diverted pouch. 

Should have also said Jan, that my rheumy is also in the process of getting me onto humira. 

If you are not going to reconnect your j-pouch why not have it removed?  I know you have problems elsewhere but it seems it's removal would rid you of the pouch problems.

Does anyone know if it's removal would calm the other non pouch problems down?   

HI Marie, yes that's the unknown - i've read and heard  of cases where the arthritis resolves with pouch excision, and some where it doesn't - so its a bit of a gamble. There are many different forms of arthritis so that's part of the puzzle - confidently resolving which form it is. My rheumy just lumps it in the inflammatory / spondyloarthritis group. My feeling is its linked to bowel related flares. 

Another reason why they call them "medical practices". Not much is crystal clear. I hope whatever treatment plan you decide to take works.

Well, here's the thing: 

If you have a spondyloarthropathy, it follows its own flare and remission pattern, often independant of the gut flares. This is why it can precede the onset of IBD by years or decades, or manifest long after colectomy. The peripheral arthritis of IBD tends to coincide with IBD flares.

And yes, you can have both types of IBD related arthritis, and osteo arthritis too. This just makes it pretty near impossible to completely sort out. So, you just go with what your doc thinks makes the most sense. Nobody ever suggested to me to have a pouch removal for this. But, then again, my j-pouch is not diverted.

Jan

I have a healthy pouch and no problem and have Enteropathic Arthritis with flares.

Been battling the enteropathic arthritis for a couple of years. Both GI and Rheum MDs felt if I could get the chronic pouchitis/GI symptoms under control that the joint pain would improve. Between the two of them I'm currently taking Hyocasamine, endocort and Imuran. Took a lot of adjusting of meds to get off the prednisone and hoping to stay off. Am still on rotating antibiotics. Do have a sulfa allergy so that takes some things off the list of options. Next step is biologics if this doesn't work. Good luck in finding the right combo that will work for you