Remicade

The pain you describe is exactly what the description of plantar fasciitis is like (being a fellow sufferer, believe me, I know!).

Two things come to mind:

1. Cipro side effects
2. Enteropathic arthritis

The plantar facsia is contiguous with the Achilles tendon. Cipro is known to have a side effect of tendon inflammation, especially Achilles, and rupture is associated with Cipro. So, something to look into, especially with long term Cipro use.

Plantar fasciitis is also associated with enteropathic arthritis. You'd think that if is is what you had, the Remicade would take care of things. That is of course, unless it is not working for you anymore. The fact that you did well with activity might seem contradictory, but with inflammatory arthritis, pain and stiffness improves with activity and worsens with rest and inactivity. This is why it is worse at night and first thing in the morning.

I would try to get into see your rheumy sooner rather than later, especially if you are due for another Remicade infusion before then. You really need to look into whether it is time to beg off of the Cipro or not too. The ANA is a puzzle, but it could easily be due to the Remicade (drug induced lupus, not a true lupus). I think it is less likely to be a primary lupus diagnosis. Yet another reason to have your Remicade reevaluated. You do not necessarily need to avoid all biologics if it turns out you need to stop Remicade (plus, wouldn't it be nice not to have IV infusions in the office?).

Hi Jan, Thank you SO much for the information. My colorectal doc has decreased the Cipro in half. He was adamant that I see the rheumy a.s.a.p. The frustrating part of this is, in our area there is one rheumatology group and appointments are very difficult to get. I have an appt. on Sept 26th. My next infusion is in August. Do you think a podiatrist may be able to help with the plantar fascitis?

Thanks! Lisa

Podiatrists treat plantar fasciitis all the time. It's hard to know if this is run-of-the-mill plantar fasciitis, but the condition is pretty common.

Yes, the podiatrist could help. Still I would be very hesitant to go forward with the next Remicade infusion with the positive ANA, even if it was not constant. You may find that the reduced Cipro dose is enough, but if your foot pain remains, I would not want to stay on it at all. Tendon rupture is definitely not something you want.

Scott is right that plantar fasciitis is quite common, but with the meds you are already on, I think it is above the podiatrist's pay grade. That said, I saw a podiatrist before I saw my rheumy for my enteropathic arthritis diagnosis. No harm done (especially since I did not want to consider surgery), but it was mostly a waste of time. He could at least evaluate x-rays.

But, if the Remicade is not doing its job, you need to be reevaluated. It takes the longest to clear the system of all the biologics. That is why I think you should not have another infusion before being evaluated. Can your GI put in an urgent referral to the rheumy to expedite this? They always leave room for urgent/emergency consults. You just cannot call it in yourself though.

Jan