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How exactly do steroids work?

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Posted 1/9/2013 7:44 PM (GMT 0)
So after almost 15 months of hell, and all the false hopes inspired by diet changes and supplements, these hydrocort enemas are putting out the fire. So far so good.....


How the hell do they work exactly, does anyone know?
Posted 1/9/2013 7:55 PM (GMT 0)
In simple terms corticosteroids block the inflammation process, and they do so very effectively, both topically and systemically. They block molecules involved in the inflammation process and they suppress white blood cells too. They are the creme de la creme of anti-inflammatories, but of course they have serious side effects when taken at high doses for extended periods and therefore only are used a bridge to other therapies with fewer side effects.

I read somewhere that they reset and "reboot" your immune system which is what us UC sufferers need some times.
Posted 1/9/2013 8:15 PM (GMT 0)
When there is inflammation, it is signed by inflammatory molecules of various kinds, mainly prostaglandins. And the inflammation goes up. Cortisone bind glucocorticoid receptors, which are present on almost each and every cells. In the whole signaling cascade, active form of Cortisone/Pred, Prednisolone, made by the liver acts on phospholipase A2 inhibitory proteins, lipocortins. This action in turn reduces expression of Prostaglandins and hence reduction in inflammation.

This is the shortest explanation I can give, does it make sense?
Posted 1/9/2013 9:02 PM (GMT 0)
I personally think that the reset and "reboot" your immune system is a crock, always has been. It stops the immune system attack while you are on it but once you are off your immune system is reset and rebooted to go back on the attack again, not rebooted to normal. That's why most everyone relapses after tapering to a low dose or completely off and also why you have to take other meds like 5ASA's to remain in remission. If your immune system was really rebooted you would be cured and you wouldn't have to take anything, including the 5ASA's.
Posted 1/9/2013 9:12 PM (GMT 0)
" If your immune system was really rebooted you would be cured and you wouldn't have to take anything, including the 5ASA's.
--------------------------------------------------------------------------------
"

word. I want my immune system rebooted, though. I don't care how.
Posted 1/10/2013 12:32 AM (GMT 0)
Thanks everyone..

Is it really true that "almost everyone" goes back to inflammation? Many, sure, but almost everyone? Certainly inflammation feeds off of itself, and quelling it can allow lesser anti inflammatories or just "regular" health to have a chance to maintain that normalcy... at least for a time.

On that note, what is the effect on the liver of long term 5 ASA use?
Posted 1/10/2013 12:34 AM (GMT 0)
For example, I used to get a rash behind my ears, did for years, super itchy and raw... took some mild steroid cream and boom..... gone and it really doesnt return. If it does, a simple reapplication takes it out.
Posted 1/10/2013 1:29 AM (GMT 0)
Freddy, There's a big difference between having an allergic reaction such as poison ivy, etc. which goes away with the help of pred and an autoimmune disease. Autoimmune diseases are usually always chronic.
Posted 1/10/2013 2:24 AM (GMT 0)
Who said anything about poison ivy and allergies??? Im talking about autoimmune skin rashes, that were chronic for years until I applied a topical steroid, which essentially stopped it in its tracks. I had an incomprehensibly itchy butt crack, and rashes behind my ears, for many many years.... I went by all the symptoms, got thyroid tests, you name it. Basically got a mild steroid, a few days of application... gone.
Posted 1/10/2013 2:47 AM (GMT 0)
Are you saying they have gone away forever? If they were chronic more than likely they will come back, just like UC unless you keep at it. I hope I'm wrong. My almost 8 year old daughter has exzema. A couple of years ago she had it so very bad they gave her a short dose of prednisone and it cleared right up, lickity split. It wasn't long before it returned. We have to put topical cream on her every single day and even that doesn't stop it in it's tracks. It is a constant fight but we don't want to do the prednisone thing again.
Posted 1/10/2013 2:54 AM (GMT 0)
Its come back very weakly and rarely, and sometimes goes away on its own but if not literally one or 2 applications of the cream does it. Theres no doubt its a total spontaneous auto immune thing though... not an allergy.
Posted 1/10/2013 5:35 AM (GMT 0)
The GI doc who first diagnosed me claimed that most people who have trouble tapering off UC have trouble because they tapered too fast. That always stuck with me. Keep in mind that basing your opinions on what you read on a site like this is anecdotal, because we are not a good representative sample of all people with U.C. as our disease tends to be more severe and chronic, otherwise we wouldn't be here in the first place! I think it's best to avoid sweeping generalizations because there are many different courses this disease can take, and what works for one person may not work for someone else. I have a friend who tapered off prednisone successfully and only needed 4 asacol tabs for maintanance, and she's been in remission for almost 15 years with only mild flare ups that were self correcting. People like her rarely come to a site like this, so we don't hear their stories as often as we hear about the tough hard to treat cases.
Posted 1/10/2013 2:32 PM (GMT 0)
I've never really believed this, particularly in regard to prednisone. UC is my second autoimmune disease and I have heard the same stuff with both, where patients believe they are the unlucky ones who continue to fight the disease whereas others got better and didn't have to fight it anymore. I believed it at first with my first autoimmune disease until I gained enough knowledge to realize that it is a psychological thing where you get depressed because you think others got better but you are just one of the unlucky ones who didn't. Doctors even lie to you about the statistics. With my first autoimmune disease I was told that prednisone works about 80% of the time. Since it didn't work on me I was depressed that I was one of the unlucky 20% where it did not work. After gaining more knowledge I learned that the real statistics were that prednisone worked 80% of the time AS LONG AS YOU CONTINUE TAKING IT and that it worked closer to 0% of the time in actually achieving remission while getting totally off the drug.

Sure, there are those with UC who got better from the pred and remained in remission by a maintanence such as Asacol but they do continue to fight the disease by the mere fact that they have to continue taking Asacol and if they don't they will be back to square one. Almost nobody gets better with pred alone, discontinues all meds, and remains in remission for very long. If you look at all the sites (thousands) for UC they all say that it is a chronic life long condition with no cure. I don't believe you will find any site anywhere which states that many can achieve long remissions by taking prednisone or any other med. There's a reason for that - because it doesn't happen very often. The only remotely encouraging thing I have ever read from any of these places which describe what UC is, is that surgery is the only cure. If so many were helped by just taking a short course or prednisone along with Asacol then the sites which describe what UC is would word their information more encouragingly instead of saying that UC is a chronic lifelong disease and the only cure is surgery.
Posted 1/10/2013 4:18 PM (GMT 0)
I think we are indeed a bit unlucky. I think this (below) understates it a bit, but lots of people do have mild to moderate disease which is obviously more manageable, yet probably still annoying to deal with.

From here:

digestive.niddk.nih.gov/ddiseases/pubs/colitis/

NIDDK said...

Most people diagnosed with UC have mild to moderate symptoms. about 10 percent have severe symptoms such as frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps.1 UC can also cause problems such as joint pain, eye irritation, kidney stones, liver disease, and osteoporosis. Scientists do not know why these problems occur, but they think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when UC is treated.

1Doherty GA, Cheifetz AS. Management of acute severe ulcerative colitis. Expert Review of Gastroenterology and Hepatology. 2009;3(4):395–405.

It's says 10% have severe disease. I would think it is closer to 25% as that is the percent that ends up having surgery, although this may be decreasing with better medical management.

But I agree, UC is chronic, and prednisone is not a cure. The severity and response to meds is what is highly variable.
Posted 1/10/2013 4:36 PM (GMT 0)
freddy - the best way to avoid poison ivy in your butt crack, is to not crap in the woods - but if you do, keep your pants on :-)
Posted 1/11/2013 4:33 PM (GMT 0)

C_G_K said...
The GI doc who first diagnosed me claimed that most people who have trouble tapering off UC have trouble because they tapered too fast. That always stuck with me. Keep in mind that basing your opinions on what you read on a site like this is anecdotal, because we are not a good representative sample of all people with U.C. as our disease tends to be more severe and chronic, otherwise we wouldn't be here in the first place! I think it's best to avoid sweeping generalizations because there are many different courses this disease can take, and what works for one person may not work for someone else. I have a friend who tapered off prednisone successfully and only needed 4 asacol tabs for maintanance, and she's been in remission for almost 15 years with only mild flare ups that were self correcting. People like her rarely come to a site like this, so we don't hear their stories as often as we hear about the tough hard to treat cases.

Yeah thats what I was saying in the first post.. but Im taklking about maintenance here not cold turkey. I mean when I first got DXd I took a course of flagyl, thhn 1 dose of pred beofre deciding against it... I still achieved remission with asacol in 1 month. But I got off it and relapsed....
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