Prednisone not working this time!

I have had UC since my late 30's. I am 59 so almost 20 years. It has been mild-moderate and been mostly controlled. I get a flare up every 2-3 years and it gets worse each time. Had one in Nov 2018. Cleared up completely with Delzicol (max dose) and Prednisone 40 mg and then taper to 10 mg within 1 month. Fast forward - lots of work stress, family stress. Another flare May 2019. This time the prednisone is not working as well. It's concerning b/c it has always worked through the years. Tomorrow I go for a sigmoidoscopy to see what is going on. Most of my UC is in lower colon and rectum. I have bleeding, mucous, urgent stools. Sometimes 5 times a day, sometimes 1, sometimes none. It's all over the place. I have had bright red blood. Possible hemorrhoids as well. I am worried that I may have rectal cancer b/c this time is different and not being controlled. Any one out there with similar experience? What would be next line of defense? What type of drug? Increase prednisone?

Thanks for the reply. I had the sigmoidoscopy this morning. Rectum and part of sigmoid are very inflamed. I need to stay on 20 mg prednisone and also a hydrocortisone enema for a month. He didn't mention rowasa. Is that a steroid enema? If this doesn't work, I will need to consider the next line of drugs - humira, entyvio, remicade. Those drugs scare me for many reasons. Can anyone tell me their experiences with them, good and bad? Do they really affect your immune system, do they help you achieve longer remission?

Post Edited (MLP2060) : 6/12/2019 12:57:22 PM (GMT-6)

Biologics are much safer than prednisone in the long term, pred can also reduce ability to fight infections. Pred is ok to take short term, being stuck on it for months is risky. I have met people who said remicade worked immediately for them. Entyvio is the slow one (up to 14 weeks) but is supposed to be safer as the action is mostly targeted on the digestive tract and to a lesser extent the respiratory tract, while remicade affects the whole body. I have been on both remsima (a biosimilar to remicade) and entyvio. They helped me a bit but not enough. No major negative side effects on either. I did catch a lot of colds on entyvio. Prednisone gave me severe osteoporosis in my 30s.

I've been on remicade for about 8-years now, I am not sick any more than my normal, I have not experienced any side effects, I attained my 1st remission thanks to remi, and have been well managed with only minor and infrequent flares since.

Everyone is initially a little scared when considering taking biologics, present party included. What helped me greatly was looking at the actual odds of benefits and risks. The odds of a biologic improving your UC symptoms is around 65%. The odds of the scary, black-box warnings on the label are all rare, less than 1% odds. The benefits far outweigh the risks. The most concerning side effect of these medications is lymphoma which has odds of 6 in 10,000 (or 0.06 percent) compared to 2 in 10,000 ( or 0.02 percent) for the general population. What happens to those who get the lymphoma, 66% are able to put it into a remission. So you are talking very long odds. The Crohn's and Colitis Foundation of America is the source for these statistics, and has a good risks versus benefits discussion:

http://www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf

After a blessed 21 years in remission, I've had a recent flair that's been cooled, almost completely, by Budesonide ER 9mg (a steroid), and Rowasa enemas for the past 3 months. I still have about a pesky 10-15% to go, for full remission.

Good luck to you.