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Am I going into a flare up again? Should I take more pred?!

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Posted 4/19/2016 8:06 AM (GMT 0)
Hey guys,

Long time lurker here needing some advice! In January I went into hospital for an urgent flexi sigmoidoscopy after being diagnosed with proctitis six months before. My symptoms had got really bad (going 15 times a day, lots of blood etc). They found that my colitis had spread (now left sided) and gave me a course of pred starting at 60mg. Luckily for me I didn't seem to have any of the side effects - touch wood - but I don't know whether I wouldn't have side effects if I went on it for a second time??

I came off the pred about 5 weeks ago and my symptoms started to come back about 3 weeks ago. It seems they've stabilised though now (going to the toilet only twice a day but with quite a bit of blood each time), and I'm not feeling any of the fatigue or pain I felt in January.

The doc have me some pred to start taking again (at 30mg) if I felt I needed to (which is very reassuring to have around).

Do you think I'm going into another flare up and that this will get much worse or is it possible that I'm just having a really mild flare? But my main question is do you think I should go back on the pred just in case (the last thing I want is to have my colitis spread even further)?

Sorry for the long post!

JackMack
Posted 4/19/2016 11:32 AM (GMT 0)
Welcome. What uc maintenance medications are you taking? Prednisone is a great rescue medication but it's for short term use only. You need sufficient main medications to sustain without prednisone. It sounds like your maintenance treatment isn't sufficient to need pred again so soon...
Posted 4/19/2016 11:42 AM (GMT 0)
Like iPoop said, pred is a good band aid med, but regular meds and enemas will be most helpful. If you don't want to go back on oral pred, you could try steroid enemas. I would consult my doctor if I were you. Hope you get some advice soon.
Posted 4/19/2016 11:54 AM (GMT 0)
"Am I going into a flare up again?" possibly

"Should I take more pred?!" no

more than likely, if you don't get on some type of maintenance plan, using meds or diet, then there is a good chance you will flare again - you don't want that -
Posted 4/19/2016 3:18 PM (GMT 0)
Hopefully you are on a high dose of oral mesalamine or other colitis drug. Your disease is psreading, and pred does not stop spreading, or do anything to treat the disease.

Please describe your meds.
Posted 4/19/2016 3:53 PM (GMT 0)
Hey - sorry everyone yes, I'm currently on 3g of oral mesalazine. Previously been on mesalazine enemas and suppositories but they didn't work. Was also on steroid enemas for a while but it had spread too far for that to help.

So pred doesn't stop the spread of my colitis? I thought that by suppressing my immune system it also stopped the ulcerated part of my bowel extending further?
Posted 4/19/2016 3:56 PM (GMT 0)
The doctor also suggested putting me on azathioprine in a few weeks time - does it sound to you like the mesalazine isn't working and I should go back on the pred now so I can taper onto the aza?
Posted 4/19/2016 4:53 PM (GMT 0)
Generally, if you've been simultaneously on 4g of daily, oral mesalazine and nightly 4g of a salofalk/pentasa enema and still experience uc symptoms, then azathioprine is the next stop.

Azathioprine is a slow working medication taking 6-8 weeks to show an improvement. Usually, you're on prednisone while you wait for aza to work. Normally, you'd continue 4g of oral mesalazine and the enema while on aza as well (at least initially). If you achieve remission then the dose of anti-inflammatory medications can be tapered down some (like weekly enema instead of nightly).

Prednisone can improve your symptoms while you wait for other medications to work. It does limit the immune system's attack some. Uc can still spread in extent and severity even while on pred. Pred reduces the likelihood but doesn't completely prevent spreading.
Posted 4/19/2016 5:06 PM (GMT 0)
Could I ask. The last time I was on pred my symptoms stopped entirely and I actually felt really good. Is it likely that in these circumstances my uc had stopped spreading? I.e. if I feel good and have normal BMs on pred has it probably stopped spreading further?
Posted 4/19/2016 5:32 PM (GMT 0)
Likely. I, on the other hand, still had bad symptoms despite being on 40 mgs of prednisone. So, it really depends how severe your flare is, and no two flares are the same.
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