overlap syndromPsc , how to treat - #18590

nilla

In patient with 3 years Psc and overlap syndrom , that start treatment with Udca and prednisolone and in 2th yeardswitched to budesonide and now Alk=600 Ast=50 Alt=100 , i want to know prednisolone 10 mg daily is better for maintenance or mycofenolate , to stop the progress,because i dont like mycofenolate for its terrible side effect?

Age: 27

Chronic illnesses: Just that as i mentioned

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Dr. Arsha K Isac

I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.

155 days ago

Hello ,
Continuing low-dose prednisolone is reasonable if tolerated and labs are controlled.
MMF is optional, not mandatory.
Always continue UDCA for PSC.
If your liver enzymes are improving or stable on budesonide, it is reasonable to continue instead of switching to low-dose prednisolone or MMF, especially to avoid systemic steroid side effects.
PLEASE CONSULT YOUR DOCTOR
Dont self adjust your regular medication
Thank you

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Dr. Bharat Joshi

I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.

154 days ago

Hello dear
See primay sclerosing cholangitis required comprehensive evaluation
Long term prednisolone is not recommended
However mycophenolate mofetil mmp is recommended for long term used
I suggest you to please get in person consultation from hematologist for better clarity
Regards

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Dr. Aarav Deshmukh

I am a general physician with 8 years of practice, mostly in urban clinics and semi-rural setups. I began working right after MBBS in a govt hospital in Kerala, and wow — first few months were chaotic, not gonna lie. Since then, I’ve seen 1000s of patients with all kinds of cases — fevers, uncontrolled diabetes, asthma, infections, you name it. I usually work with working-class patients, and that changed how I treat — people don’t always have time or money for fancy tests, so I focus on smart clinical diagnosis and practical treatment. Over time, I’ve developed an interest in preventive care — like helping young adults with early metabolic issues. I also counsel a lot on diet, sleep, and stress — more than half the problems start there anyway. I did a certification in evidence-based practice last year, and I keep learning stuff online. I’m not perfect (nobody is), but I care. I show up, I listen, I adjust when I’m wrong. Every patient needs something slightly different. That’s what keeps this work alive for me.

153 days ago

When managing overlap syndrome in a patient with primary sclerosing cholangitis (PSC), the treatment approach indeed requires careful balancing of efficacy with potential side effects of the medications. In situations where the patient is not responding or experiencing side effects from an initial treatment, such as switching from prednisolone to budesonide, it’s crucial to reevaluate the plan. Prednisolone and mycophenolate mofetil (MMF) are both used in managing autoimmune components, but they have different profiles in terms of effects and side effects. Prednisolone, at a dose of 10 mg daily, is a standard part of treatment for an autoimmune overlap. It can help manage inflammation but long-term use may lead to significant side effects, such as weight gain, diabetes, hypertension, and osteoporosis. On the other hand, mycophenolate mofetil is often considered when patients have intolerable side effects on steroids or when additional immunosuppression is needed. While MMF is effective in reducing steroid dependency, you rightly point out its side effects, including risk of infection and potential hematological abnormalities. Given your specific concerns about mycophenolate and its side effects, a shared decision-making approach with your healthcare provider is wise, considering both treatment goals and quality of life. Before making any changes to medications, it’s essential to discuss with your hepatologist or specialist who can monitor liver function tests closely, as elevation in ALP, AST, and ALT might suggest ongoing inflammation or disease progression. They may also evaluate other risk factors or comorbidities that might influence treatment choice. Monitoring and adjusting treatment is often necessary over time to optimize outcomes, so regular follow-up and lab checks are key to reassess liver enzyme levels and overall liver function.

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