I think when flaring that you should go up from 2.4g of Lialda to 3.6g or 4.8g, and you should certainly try the rectal meds. You can do the 5-asa, or if you think the more topical steroid may not be a problem, then begin with steroid enemas then move to 5-asa enemas.
You should also discuss oral or rectal budesonide steroid. (One brand name is Endocort.) You take less of it then Pred, and its elimination from the body is more rapid and less of a burden. Pred is preferred to cortisone because its affinity for the receptors that the steroid needs to bind to to do its job is 4x greater. Well budesonide steroid is 4x greater then Pred (16x > cortisone). So you take much less.
Sometime in the next few months there will be an intestinal-release version which has even less opportunity for systemic absorption.
IF the flare is not too bad, I believe probiotics can be helpful. Initially work up to a heavy dose (may be some gas issues on the way) then taper down to a more affordable level after symptoms improve (or several weeks).
Post Edited (DBwithUC) : 1/11/2013 2:48:11 PM (GMT-7)