How long until symptoms clear did you start tapering Prednisolone

Heya,

I had my second ever flare up at the beginning of last month which came as a shock after being in denial/ med free for over a year. I was given pred straight away to treat the flare and got 3.6g mesalazine and pentasa enemas every night added to the pred a week later.

Been on pred for a month doses varying from 40mg-30-40mg. At the start of the flare I took 40mg of pred for 2 weeks along with mesalazine and the pentasa enemas. And then went down to 30mg for a week and stopped the enemas and began flaring again. I had to increase dose back up to 40mg and started the pentasa enemas again which I have been on for 10 days. My GI said yesterday that as I am now 'symptom free' again I can start tapering my pred 5 mg a week. Trouble is I'm too scared to start tapering as I'm worried reducing the dose will cause me to flare, I feel great at the moment, 1 bm a day no pain, no blood and no mucus. I hope I will taper better this time as I will be doing it slower and I have taken the mesalazine for longer, so it will have had more of a chance to work (get in my system) and I won't stop the pentasa enemas.

How long do you guys usually wait until you start tapering off the prednisolone after a flare??? Do you alway wait until you are symptom free? I know I can't stay on pred forever, but I'm worried as my doctor said if I flared again while tapering would have to consider adding azathiprine which I'm very reluctant to start.

Thanks in advance

x

The thing is prednisone weakens your immune system, giving your colon time to heal but it does not fix the underlying problem, your body's immune system attacking itself. Once you taper back or get completely off the pred your body resumes the attack all over again. The amount of time where you begin flaring again depends on how well your colon is healed in the first place and what other kind of maintenance meds you are on. If your colon is completely healed it may be a long time before you start flaring again or it could be a lot sooner. During tapering of pred and after getting completely off of it you have to continually do something to remain in remission, otherwise there is a good chance you will eventually have another flare. That's why your doctor is talking about Imuran. Assuming you can taper completely off of the pred make absolutely sure you continue doing something to remain in remission, forever.

I would stay on the 5-asa at a maintence dose. it mostly acts topically, and does not really "get into you system" so a few BM after the last dose and it is gone. In some studies some anti-inflammatory supplements have worked for maintence about as well as 5-asa, so you might be able to hse an herb instead of the prescription. But I would do something to maintain. There is no guarantee the next flare will end.