calling SonicBandaid - question re prednisolone post Tx

Hi
I hope you don't mind me trying to make use of your medical knowledge. I am 21 months post treatment, undetectable throughout tx and at 6 and 12 months post, but I have been plagued throughout the post tx period with fairly minor but annoying joint pains (Wrists, finger joints, feet and knees at various times) and a flaky exzema (eczema)-like rash on my forehead and in the creases either side of my nose. My consultant agrees with me that these are caused by a persistent immunological dysfunction subsequent to the interferon treatment but says we are in 'unknown territory' as far as medical knowledge is concerned about why this occurs with some people and how long it might last.

Anyway I now have all of the above combined with a re-occurrence of my Crohn's (fortunately very minor, restricted as previously to mild ulceration at the very lowest end of the colon, but again annoying with a bit of bleeding and 'toilet problems'). The previous episodes of this were a few years pre-tx and were fixed almost instantly by a course of prednisolone. This treatment also cleared my flaky scalp I noticed. I am about to go to my GP with this collection of symptoms and I think he may want to prescribe prednisolone again. I know this will bring me (perhaps temporary) relief not just to the Crohn's but also the joint pain and the skin problems (the eczema responds very rapidly to 1% hydrocortisone cream but I don't like to put this on my face for more than a couple of days at a time).

My question after this long winded spiel is: is there any evidence that low-dose systemic cortico-steroids might be associated with HCV relapse after nearly 2 years of SVR? Would a month's course be safe do you think? I am not asking for guarantees, just an informed opinion as my doctors don't have a clue about this (despite being excellent in many other respects).

Thanks in advance to you or anyone else who can provide any evidence based opinion on this,

Tim

[Sunny37]

Hi Tim,

I am sorry to say that I cannot answer your questions but I am soooo happy that I didn't miss your post!!! I too have crohn's and was diagnosed with this disease from a transfusion in 1986. I just took my 4th shot on Monday and have no real side effects...a bit dry, tired, the most bothersome is that I am going to the washroom like 15 to 25 times a day....I have had 4 bowel resections and had to take some serious meds over the years (methotrexate,prednisone,immurane) and am now taking remicade in conjuction with interferon....maybe that's why this medication isn't hugely bothering me ......I am sooo used to crazy side effects. WHat my major concern is that I won't get proper absorbtion of the riba with "running to the washroom" all the time. can you spare 5 minutes and tell me how this course of meds effected your health? I would love to hear from you....I am genotype 3a.
look ofrward to hearing back from you.

[pigeonca]

I'm not a doctor, so don't take this as the gospel truth, but I do suffer from auto-immune problems that come from the hcv itself (I believe) as well as from SOC treatment.  Some of your symptoms resemble mine, especially the flaking skin.  I've never had dandruff in my life, and now I can make enough snow to fill a movie set.  My dermatologist says it's an autoimmune reaction, as was another skin problem that started about a year or so before I was diagnosed with hep c.  It's called morphea, and it's a form of scleroderma.  I suspect this was first a reaction to the interferon my body was pumping out to counteract the hcv virus - and subsequently a reaction to Peg-Intron, i.e. manufactured interferon.  Correct me if I'm wrong, but isn't Crohn's also autoimmune?

There are all sorts of immune modulators and other meds you can use as an alternate remedy to prednisone, but your hep doctor needs to be consulting with a rheumatologist and a dermatologist to really know how to give you the care you need. Good luck...

[timlotus]

Thanks for your replies guys!  Sunny I am sorry to hear about the problems you are having :(
I was lucky enough not to have any flare-up of Crohn's while on treatment so I did not need any meds for it, although my liver specialist thought it might happen and that it could be managed in the usual way. I so hope thatis true for you too, and that you can continue with your treatment. I am not a doctor but I would have thought your concern about the riba not being absorbed is a sensible one. I can't remember if the riba tablets i had were 'enteric', ie meant to be absorbed in the intestine, or not. I wish you all the best with this.

Pigeonca thanks for your advice. very helpful :)
i do believe most of my medical problems including the Crohn's are related to my previous HCV infection, and are mostly auto-immune, provoked by my immune system fighting the virus. I believe in some cases the immune system fails to settle after treatment and some of us continue to get problems. It by no means implies a return of the virus. Most of those with continuing problems are SVR according to my informal data collection in the past year.

I have also had lichen planus outbreaks and joint pain and skin problems are classic immunological issues.

Thanks again.

Tim

[SonicBandaid]

Hi timlotus,
Sorry to take so long to return your post; I have been away on vacation.  If you have had a SVR for 21 months low-dose (or, for that matter even high dose) prednisolone should not be a problem for you.  There isn't much literature on this point for HCV, but as the vast majority of patients with long term SVR have cleared replicating HCV 5 mg prednisolone should not cause problems.

HBV is a little different and there may be extremely low level HBV actively replicating in lymphoid tissues and liver that may be reactivated, for example, by cancer chemotherapy and high dose steroids.  Many clinicians, myself included, would retreat these patients [with treated HBV]  "prophylactically" for the duraction of such cancer treatments.

Cheers,
Sonic