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Advice for prednisone please

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Ulcerative Colitis
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Posted 6/1/2023 7:23 PM (GMT -5)
Hi everyone! My GI just prescribed me prednisone and the dose and tapering that she prescribed is feeling weird to me. Could anyone tell me your experience with a short course of prednisone to see if it aligns, or what you think about this?

I’ve been in a small flare that went from bad to mild basically the instant I reduced my stress levels (took a leave from work). That was eight weeks ago, but still having some minor symptoms, like loose stools and gas. However, the main issue is what seems to be IBD associated arthritis. I don’t have this diagnosis yet, and it’s really a big question for another time. But because of my colitis symptoms my doc recommended this dosage:

Pred: 20mg/day for one week. Each week, reduce by 5mg (so 15mg week two, etc). In total that would be a four week course. I’ve had friends who do just one or two weeks total of pred for other AI diseases, but does this sound like what you’ve all done for colitis? It seems long and a conservative taper to me. If it helps, I’ve been on remicade for ten years.

Any thoughts are appreciated!
Posted 6/1/2023 7:42 PM (GMT -5)
Tapering 5 mg/wk is normal. Starting at 20 mg is unusual. Whenever I had to take pred for a flare I always was started at 40 mg/day tapering for 6-8 weeks. You are on a low dose but normal taper.
Posted 6/1/2023 7:44 PM (GMT -5)
If all you're having is loose stools and gas, then I wouldn't be taking prednisone at all. I can't speak to the arthritis as I've never experienced that.

A typical pred dosage and taper for a UC flare starts much higher than what you were prescribed. It is typically 40 mg for 2 weeks, then taper by either 5 mg or 10 mg each week thereafter.
Posted 6/1/2023 7:46 PM (GMT -5)
That sounds like a relatively decent schedule to me. Some of us go through multi month courses of pred starting with a 40mg dose or even higher.

Though if you feel like you have arthritis, and your colitis symptoms are really mild and you feel like they’re improving….I may try to avoid taking pred unless the symptoms start getting worse.

Obviously your doctor knows best, and most people on here probably know better then me.😁
Posted 6/1/2023 7:55 PM (GMT -5)
Thanks! To clarify, I would definitely be ignoring this prescription altogether if it weren’t for the arthritis, which has completely shut down my ability to do anything right now. My GI is hoping that the pred helps with both the Gastro symptoms and the joint pain. So tough having two things at once.
Yes, she mentioned that it usually starts at 40 but because my symptoms are so mild she wants to see how 20 does. Sounds like the taper schedule is pretty normal though.

Anyway, I’m just confused :/ I want to do right by my body and I can’t seem to figure out what’s what with all this inflammation throughout.
Posted 6/1/2023 11:36 PM (GMT -5)
Maybe you need to consult a rheumatologist about the arthritis. Did your gastro do any blood tests before RXing Pred? When was your most recent Remicade infusion? Most of us try to stay off Pred except in case of severe UC inflammation due to its known side effects. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)
Posted 6/1/2023 11:51 PM (GMT -5)
Rheumatologists in my area are booking for October unfortunately. I did have blood work and it’s showing limited inflammation, which is another reason I’m so confused because I clearly FEEL inflammation but now have two labs saying otherwise. I’m glad I posted here. I was feeling uneasy about the steroids and you all seem wary as well. I guess I’ll keep thinking about it and try to get my scope pushed up if I can find the money for it. In the meantime, at least I’m not running to the bathroom god bless!
Posted 6/2/2023 12:32 AM (GMT -5)
It might be a good idea to book with a rheumy for October and ask if the practice can put you on a wait-list for possible cancellations. We have a very experienced member on the forum who recently moved to another state then couldn't get an internist quickly due to heavy booking, but was able to see the doctor's nurse practitioner-- so, a foot in the door. I just mention that because you seem to be especially bothered by the arthritic discomfort now. Did the gastro clear you to take regular Tylenol? Mine doesn't recommend the extra-strength because it contains codeine, which can negatively affect bms, but is OK with regular. Are you losing sleep due to arthritic pain? Or does moving about during waking hours cause you more discomfort? Or is stiffness your worst arthritic limitation? Sometimes application of heat or a topical lotion with 30% salicylate can help relieve the discomfort short-term. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)
Posted 6/2/2023 4:59 AM (GMT -5)
I don't think any OTC Tylenol contains codeine. That would be a prescription strength that I think is called Tylenol 3. I use arthritis strength Tylenol that is OTC and it doesn't have codeine in it.
Posted 6/2/2023 6:39 AM (GMT -5)
It definitely doesn't have codeine in the U.S. if it's over the counter. I think some other countries do though.

That makes sense, Hill Hunter. One course of prednisone isn't going to be a big deal. However, sounds like you're really struggling with the arthritis. My labs don't always show anything, even when I'm flaring quite badly.
Posted 6/2/2023 7:18 AM (GMT -5)
Sounds like what has helped me if things were not too bad.

I really wish prednisone were not so bad for you because it sure does work.
Posted 6/2/2023 8:57 AM (GMT -5)
What other meds are you on for UC? I hope you are requesting a referral to a rheumatologist anyway despite the waiting time.
You could skip the pred and try Celebrex.

q
Posted 6/10/2023 12:13 PM (GMT -5)
At my first hospital the standard starting dose for prednisone was 30mg. I do sometimes wonder how my UC course would have gone if I'd started on 40mg 🤷🏾‍♀️ I guess not much different...
Posted 6/10/2023 1:57 PM (GMT -5)
I wasn't even given pred when I first got UC! And I was so ill, I thought I was dying and I kind of wished I would, too. I was sleeping on the bathroom floor, waking up every 15 minutes to pass blood and what looked like bits of my colon. The pain was unbearable. I remember at one point crawling to my kitchen to try to get something to drink. Any movement made me have to go to the bathroom. I do not know why they didn't give me prednisone or hospitalize mme.all they gave me were 6 pills of Asacol daily and Bentyl (which did nothing). A general surgeon did my scope but you'd still think he would know to give steroids.
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