The Connection Between Prednisone, Inflammation, and Calprotectin
Prednisone is a corticosteroid, a class of medication that works by suppressing the immune system to reduce inflammation. Its anti-inflammatory properties are why it is frequently prescribed to induce remission during an inflammatory bowel disease (IBD) flare-up. A fecal calprotectin test is a common non-invasive tool used to measure the level of inflammation in the intestines. Calprotectin itself is a protein released by immune cells, primarily neutrophils, that flock to sites of intestinal inflammation. High levels in a stool sample indicate that intestinal inflammation is present.
Can prednisone cause high calprotectin?
No, prednisone does not cause high calprotectin levels. The relationship is the reverse: high calprotectin indicates intestinal inflammation, and prednisone is prescribed to treat that inflammation. The confusion arises when patients' symptoms improve on prednisone, but their follow-up calprotectin test results remain elevated. In this scenario, the elevated reading does not mean the prednisone is causing inflammation; rather, it indicates that the medication has not fully resolved the underlying inflammatory process.
Why Calprotectin Levels Can Remain Elevated During Steroid Therapy
Research into the effect of corticosteroids on calprotectin levels has revealed a few important insights:
- Ongoing Subclinical Inflammation: Even when prednisone brings about a significant improvement in a patient's symptoms, the medication may not entirely eliminate the intestinal inflammation. A high calprotectin reading, in this case, serves as a biomarker for ongoing, low-level (or subclinical) inflammation that the medication has suppressed but not fully healed.
- Indicating Treatment Resistance: In some cases, a persistently high calprotectin level during prednisone therapy can indicate that the patient is not responding adequately to the treatment. A study found that higher fecal calprotectin levels predicted steroid non-response in patients with specific forms of colitis.
- Predicting Future Relapse: Studies have shown that a decline in calprotectin levels after discontinuing steroids is followed by an increase in many non-steroid-dependent children with chronic colitis. This suggests that the medication is simply masking the underlying disease, which becomes active again when the immunosuppressive effect wears off. Interpreting the test helps physicians gauge the true state of inflammation and the likelihood of relapse.
Interpreting Calprotectin Results While on Prednisone
Correctly interpreting fecal calprotectin results while taking prednisone is crucial for effective disease management. Here is a general guide:
- Significant Decrease, Still Elevated: Your calprotectin level has dropped significantly since starting prednisone, but it remains above the normal range. This is often a sign of therapeutic success, but it indicates that while the inflammation is suppressed, the disease is not in full remission. Your doctor may plan for a steroid taper or transition to another maintenance therapy.
- No Significant Change: Your calprotectin level remains very high despite taking prednisone for several weeks. This suggests a lack of therapeutic response. Your physician may need to adjust your treatment plan, potentially switching to a different type of medication.
- Returning to Normal Range: Your calprotectin level has returned to the normal range (<50-120 mcg/g). This indicates that the treatment has been highly effective in resolving the intestinal inflammation.
Other Factors Influencing Calprotectin Levels
While prednisone does not cause a high reading, it is important to remember that calprotectin can be elevated by other conditions besides IBD.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen can cause a transient, mild elevation in calprotectin levels.
- Gastrointestinal Infections: Bacterial infections in the gut can lead to inflammation and a temporary rise in calprotectin.
- Other Conditions: Celiac disease, colorectal cancer, and even mild inflammation from functional disorders can sometimes cause a borderline elevation.
Comparison of Anti-Inflammatory Effects on Biomarkers
| Inflammatory Marker | How Prednisone Affects It | Effect on a Persistent High Reading | How to Interpret while on Prednisone |
|---|---|---|---|
| Fecal Calprotectin | Decreases, but may not normalize; indicates ongoing gut inflammation. | High reading suggests incomplete therapeutic response or ongoing inflammation. | A persistent high reading means the underlying disease is not fully controlled, regardless of symptomatic relief. |
| C-Reactive Protein (CRP) | Typically decreases significantly and quickly; can be artificially suppressed. | False Low: A reading might appear falsely low, masking the true level of systemic inflammation. | Values must be interpreted cautiously, as prednisone can rapidly and substantially lower CRP levels. |
| Erythrocyte Sedimentation Rate (ESR) | Often lowered by corticosteroids, can give a falsely low reading. | False Low: Similar to CRP, ESR may appear lower than the actual systemic inflammatory state. | Caution is necessary, as the value may not accurately reflect the extent of inflammation due to the drug's effect. |
Conclusion
In summary, prednisone does not cause high calprotectin, but its anti-inflammatory action can reduce it. If your fecal calprotectin test remains high while taking prednisone, it indicates that intestinal inflammation is still present, even if your clinical symptoms have improved. This crucial insight allows your healthcare provider to assess the effectiveness of your treatment and make informed decisions about your ongoing care. Always consult with a medical professional to correctly interpret your test results within the context of your overall clinical picture.
Mayo Clinic's discussion on fecal calprotectin as a biomarker provides a useful overview.
