Is it normal for ulcerative colitis to return after steroids?

Question

Hello doctor,

My elder sister is 41 years old and has ulcerative colitis. She is currently taking steroids during a flare-up. She is worried because her symptoms improve while she is on the medicine, but they come back when the dose is reduced. I want to know the following:

Is this common with steroid treatment in ulcerative colitis?
Are there safer long-term medicines to help keep the disease in remission?
Would biologic therapy be an option in such situations?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

People with ulcerative colitis (a long-term condition that causes swelling and soreness in the lining of the large intestine and symptoms such as diarrhea, stomach pain, and sometimes blood in the stool) often feel better while taking steroids but find their symptoms come back when the dose is reduced.

Steroids like Prednisolone are very good at calming inflammation during a flare, but are not for long-term use. Using steroid medicines for a long time can cause side effects which include weakening of the bones, weight gain, diabetes (high blood sugar levels), and infections.

When symptoms return during steroid tapering, doctors often call this steroid-dependent disease. In such cases, the usual approach is to start long-term medicines that help keep the disease under control without relying on steroids. These are called steroid-sparing treatments.

Another possibility is immunomodulator drugs such as Azathioprine. These medications help control your immune system and decrease inflammation over time, which helps keep you in remission. Another important alternative is the biological treatment.

Biological medicines (e.g., Infliximab or Adalimumab) are made to target specific parts of the immune system that cause inflammation in ulcerative colitis. These therapies are usually recommended when the disease is poorly controlled with conventional drugs. Doctors usually do screening tests for infections and review the patient’s overall health when beginning biologic therapy.

Once treatment begins, patients are seen regularly for blood tests and follow-up to make sure the medicine is working well and safely. The main aim of treatment is steroid-free remission, which means the disease is controlled without repeating courses of steroids. As your sister’s symptoms return with a decrease in the dose of steroid, it might be worth her talking to her gastroenterologist about long-term maintenance therapies.

With modern therapies and proper monitoring, many people with ulcerative colitis can achieve stable remission and live a good quality of life without long-term steroid use.

I hope this helps.

Please revert in case of further queries.

Thank you.