How to manage Crohn's disease effectively?

Question

Hello doctor,

My 36-year-old wife has Crohn’s disease and is currently on ustekinumab (an interleukin-12 and interleukin-23 inhibitor, a biologic therapy). Her most recent colonoscopy showed good mucosal healing. However, her C-reactive protein (CRP) level remains mildly elevated at seven, and she frequently experiences fatigue, despite having normal iron, vitamin B12, and thyroid function test results. A dual-energy X-ray absorptiometry (DEXA) scan revealed osteopenia, likely a result of prior corticosteroid use.

Could her persistent fatigue be related to low-grade disease activity or extraintestinal manifestations of Crohn’s disease?
Should we consider repeating imaging studies, or is it time to evaluate a possible change in therapy?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Given your wife’s history of Crohn’s disease and the fact that she is on Ustekinumab (Interleukin-12 and Interleukin-23 inhibitor, a biologic therapy) with evidence of good mucosal healing, her persistent fatigue, despite normal iron, vitamin B12, and thyroid function tests, and a mildly elevated C-reactive protein (CRP) may indeed reflect low-grade systemic inflammation or extraintestinal manifestations of Crohn's disease, such as subclinical joint or skin involvement.

The diagnosis of osteopenia further supports the presence of ongoing systemic effects, possibly due to prior corticosteroid use or chronic inflammation. While her colonoscopy findings are reassuring, disease in the small bowel can sometimes be missed during routine endoscopic evaluation. Therefore, a repeat magnetic resonance enterography (MR enterography) or a fecal calprotectin test may help assess deeper or more proximal inflammation that could be contributing to her symptoms.

If her fatigue persists and CRP levels remain elevated, it would be reasonable to question whether her current biologic therapy is sufficiently controlling systemic inflammation. In that case, reassessing the need to adjust or escalate her treatment may be warranted.

Fatigue is a common yet under-recognized burden in inflammatory bowel disease (IBD). A multidisciplinary approach, including nutritional support, mental health counseling, and guidance on physical activity, may provide additional benefit alongside reevaluation of her treatment regimen.

Please let me know if you have any further questions or if you would like to explore these options in more detail.

I hope this helps.