A man was diagnosed as UC patients after colonoscopy about a month and half ago. After that he is taking the medicine sulfasalazine and steroid to overcome the symptoms of UC. The dose of steroid has been reduced to 1/3rd that of initial dose at the moment, however he is feeling some adverse effect of the medicine at the moment such as myopathy and joint stiffness. He wish to have massage time and again to relief his myopathy. I suspect it is due to steroid consumption. How can he overcome to this side effects. No vitamins are prescribed to him and I wonder whether he should be supplemented with folic acid or not.
Mesalazine - 5-aminosalicylic acid (5-ASA) - is now the treatment of choice for induction and maintenance of remission of mild-to-moderate ulcerative colitis. in that Oral mesalazine is less effective than oral corticosteroids and so should be used as sole treatment only in mild attacks whetherTopical mesalazine is probably slightly more effective than topical corticosteroids.
Oral mesalazine is mostly used to maintain remission. Mesalazine also seems to help reduce the risk of colorectal cancer.
Modified once-daily mesalazine preparations and a multi-matrix oral formulation are now available for patients who have compliance problems.
The newer 5-ASA preparations olsalazine and balsalazide are inferior to sulfasalazine in maintenance therapy but have fewer adverse effects. Sulfasalazine has a higher incidence of side-effects compared with newer 5-ASA drugs but selected patients (eg, those with a reactive arthropathy) may benefit.
Olsalazine has a higher incidence of diarrhoea in pancolitis and is best for patients with left-sided disease, or intolerance of other 5-ASAs
http://www.patient.co.uk/doctor/ulcerative-colitis-pro
Recently role of TGF is gaining popularity in UC as is evident by this paper http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484333/
Dear Bhakta
Corticosteroids should be used only to induce remission in moderate to severe ulcerative colitis. As soon as possible, it should be completely stopped, and remission maintained with aminosalicilates, azathioprine or even anti TNF agentes, according to the evolutive behavior after stopping steroids. If the patient is not able to become totally steroid free, another alternative apart from sulphasalazine must be introduced. Thus, I think that esteroids side effects will improve as the medication is stopped.
I completely agree with Dr Catapani. Corticosteroids down regulate the hypothalamic pituitary adrenal axis leading to many untoward side effects. These drugs should therefore only be used for a brief period to induce remission. As a matter of fact this applies to the treatment of all auto immune and chronic inflammatory disorders (eg., psoriasis) not just UC.
That said, it is not uncommon for muscle and joint pain to emerge as blood levels of the drug decline. The longer the patient takes these drugs shorter the period of satisfactory relief from muscle and joint pain.
The patient should be weaned of these drugs slowly. Over the counter anti inflammatories can facilitate this process.
Here are my thoughts as a pharmacologist advising reimbursers (not a clinician!):
In selected cases, low-dose corticosteroids may be appropriate for longer-term use. Monitoring for undesirable effects, such as diabetes, electrolyte changes, mood disturbances is important, as well as preventing osteoporosis. Bisphosphonates are used in this case.
If a patient truly needs vitamin supplementation, it would seem more appropriate to review the basic therapy, as malabsorption would indicate that the UC therapy needs intensification.
Herbal Medicine works really well at supporting conditions such as Ulcerative colitis, by helping the body efficiently digest the drug and support all the other organs.