Posted 1/18/2019 3:30 PM (GMT 0)
No two flares are alike for us. So, we cannot assume that what worked the first time, will work exactly the same way a second flare. It would most certainly be great if we have a recipe that works everytime, but often that is not the case, We can have small flares that are easily beat with minimal intervention within a series of weeks, we can have moderate flares that require more intervention that can take a month or months to beat, we can have severe flares that are hell-incarnate and take many months to beat and require much, much stronger combination of meds to beat.
What are your flare symptoms? Number of bms a day? Any urgency? Any blood? Any pain? I ask as it would be helpful to ascertain if your flare is mild, moderate, or severe and those answers will help quantify it!
The first approach to a flare is often "lets try steroids." There's some logic to it, as a typical course of pred shuts off the immune attack for a couple months and that's long enough to put the immune system back into a quiescent/quiet remission state in some cases. They're basically saying, lets see if this is just a minor flare that is easily quelled. UC is defined by periods of remissions and flares, and that cycle happens to all of us even when our maintenance medications are perfect. And that's the first attempt here. If you told me you had 3-4 bms a day, a little blood, and/or slight urgency then I'd say this sounds like a good plan to at least try.
The second approach is often lets through more meds and/or higher dosages at it (often in addition to pred). This is often necessary with more severe flares, where there is disease progression in extent or severity. In this case, your maintenance medications are no longer sufficient as is. It is now necessary to keep you on stronger meds and dosages on an ongoing basis to sustain a remission. If you are having 6+ bms a day, a lot of urgency, and/or loose bms then this might be the better approach.
I'm surprised you stopped remicade, that's quite unusual. If you go back on remicade, then insist that they pre-med you with IV solumedrol. Why? You are at high risk of having anti-remicade-antibodies, that would manifest itself as an infusion-reaction, and pre-medding with steroids helps reduce the odds. When we cease a biologic we have much greater odds of having antibodies, which is why they typically do not stop it. Far from guaranteed, some do go back on a biologic just fine and have no issues at all.