IBD flares in patients with mild to moderate disease are usually managed in an outpatient setting. However, an important and sometimes overlooked concern in the management of IBD is the dosing and duration of use of corticosteroid therapy. For a flare of moderate severity, a dose of prednisone of 20-40 mg/day or equivalent is often sufficient to treat the flares. Once symptoms are controlled, a dedicated tapering progression of the steroid follows.

Patients are candidates for immunomodulators (azathioprine, 6-mercaptopurine, methotrexate) or anti-TNF agents (infliximab, adalimumab, certolizumab pegol) and biologic agents if flares are frequent (>1-2 times), if the duration of steroid use is prolonged (more than a few weeks per year), if reduction of the steroid dose causes recurrence of symptoms (steroid dependent), or if steroids do not appear to be working (steroid refractory).

A health maintenance issue of particular importance to patients with IBD is a reduction in bone density because of decreased calcium absorption (due to the underlying disease process) or corticosteroid use. Osteoporosis is a very serious complication, involving 40% of patients with IBD, and increases the risk for fractures. All patients who have been using steroids for longer than 3 months, as well as postmenopausal women, should undergo testing with bone-density studies; treatment with bisphosphonates and calcium supplements can be initiated in patients with significantly low bone density.