DEAR DR. GOTT: I am hoping you can give me some information about the treatment for colitis. I am a 49-year-old woman. Twenty-two years ago I was diagnosed with lupus which I kept under control with 5 mg of prednisone daily. After the birth of my son 10 years ago, I developed hypothyroidism and now take 100 mcg of Levoxyl daily.
My current rheumatologist thinks that my lupus is actually an undetermined autoimmune disease which has probably caused my thyroid problem and now the colitis that I’m struggling with which seems to be getting worse. I’ve been hospitalized twice because of it in the past five years. I am currently taking 10 mg of prednisone daily to try to keep it under control but my gastro doctor wants to get me off it completely because I have been taking it for so many years. This is where my problem comes in. I have tried sulfasalazine, Entocort and azathioprine to name a few but stopped because they didn’t help and they made me feel like I had the flu every single day. I can deal with the side effects of prednisone and it keeps my joint pain and colitis under control.
What are your thoughts on the treatment for colitis? Do you think a low dose of prednisone over a long period of time is harmful? I have bone density tests every two years and don’t show any signs of bone loss. I prefer prednisone because it is inexpensive and effective in controlling any inflammation.
DEAR READER: Let’s begin with the prednisone issue. This drug is a corticosteroid that prevents the release of substances within the body that cause inflammation. It is available in dosing from 1 to 50 mg. Known side effects include indigestion, increased appetite, nervousness and mood changes. Less common reactions include cardiac arrhythmias, potassium deficiency, hypertension, pulmonary edema, thrombophlebitis, diabetes, thyroid abnormalities, cataracts, gastric irritation, weight gain, an increased risk of bone fracture or necrosis (death) of the head of the femur and humerus bones, verbal memory loss, depression, and headaches to name a few. Need I say more? Practically speaking, there are times when short-term prednisone is extremely appropriate but the key here is short-term. As a general rule, prednisone should not be taken for the long haul because the side effects are too severe. (The exception is for those with Addison’s disease, in which corticosteroids must be taken to make up for low cortisol levels and for those with certain other diseases such as chronic lung disease.)
There are many types of colitis, some of which stem from autoimmune disorders. Colitis is essentially inflammation of the large intestine. Symptoms of the disorder include abdominal pain, bloody stools, abdominal pain, fatigue, bloating, loss of appetite, and more. Based on the medications your physician tried in place of the prednisone, I believe you may have ulcerative colitis or Crohn’s disease. Speak with your doctor about the possibility of antibiotics, an iron supplement if you suffer from intestinal bleeding, anti-diarrheals, OTC acetaminophen, diet modifications that limit dairy products, high fiber foods such as whole grains, fresh fruits and vegetables; be sure to include probiotics. I just stress that any changes from what you are currently doing should be cleared by your physician first.
Lupus is an autoimmune disorder that can affect the brain, kidneys, joints, skin and other organs. While there is no cure, there are drugs (one of which is prednisone) such as non-steroidal anti-inflammatories, DHEA, and anti-malarial drugs that might be considered to manage symptoms. I am unaware that lupus is linked with either a thyroid issue or colitis but oddly, the disorder can be triggered by, among other things, antibiotics. Symptoms of lupus include headaches, joint pain, Raynaud’s phenomenon, memory loss and more.
It appears your rheumatologist is on top of things and I can certainly understand the reasoning behind the attempt to discontinue your prednisone (although I would be more inclined to blame the prednisone (perhaps erroneously since I’m not totally familiar with your case) for your thyroid condition rather than an undetermined autoimmune disease). Despite its positive effects, it should probably be eliminated. Work together with your physician to find a medication to take its place that will keep your pain under control.
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