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Corticosteroids and Lupus


Corticosteroids are very powerful drugs that reduce inflammation in various tissues of the body. These drugs are used to treat many of the symptoms of lupus that result from inflammation. You can take them as pills or by injection. Corticosteroid creams or ointments are also available to treat skin rashes caused by lupus. Most lupus symptoms respond quickly to corticosteroids. Prednisone is a corticosteroid that is often used to treat lupus.

Corticosteroids are hormones secreted by the cortex of the adrenal gland. SLE patients with symptoms that do not improve or who are not expected to respond to NSAIDs or antimalarials may be given a corticosteroid. Although corticosteroids have potentially serious side effects, they are highly effective in reducing inflammation, relieving muscle and joint pain and fatigue, and suppressing the immune system.

They are also useful in controlling major organ involvement associated with SLE. These drugs are given in much higher doses than the body produces and act as potent therapeutic agents.

The decision to use corticosteroids is highly individualized and is dependent upon the patient’s condition. The decision to begin a corticosteroid is a big one and depends on your needs. Some patients may need to take the drug for a short time only, until disease symptoms get better or go away. Others with more serious or life threatening problems may require higher doses of the drug for longer periods of time.

In general, once your lupus symptoms have responded to treatment, you will gradually take less and less of the drug until you can stop completely. If it is not possible for you to stop the drug completely, your doctor will give you the smallest amount possible to keep symptoms under control.

Doctors are careful about prescribing corticosteroids because many complications are associated with taking them. As a result, it is important to take the drug exactly as prescribed. People who have been taking corticosteroids for a long time may need higher doses of the drug before, during, or after a physically stressful event, such as surgery.

Once the symptoms of lupus have responded to treatment, the dose is usually tapered until the lowest possible dose that controls disease activity is achieved. Patients must be monitored carefully during this time for flares or recurrence of joint and muscle pain, fever, and fatigue that can result when the dosage is lowered. Some patients may require corticosteroids only during active stages of the disease; those with severe disease or more serious organ involvement may need long-term treatment.

Treatment with corticosteroids must not be stopped suddenly if they have been taken for more than 4 weeks. Administration of corticosteroids causes the body’s own production of adrenal hormones to slow down or stop, and adrenal insufficiency will result if the drug is stopped suddenly. Tapering the dose allows the body’s adrenal glands to recover and resume production of the natural hormones. The longer a patient has been on corticosteroids, the more difficult it is to lower the dose or discontinue use of the drug.

Types of Corticosteroids

Prednisone (Orasone®, Meticorten®, Deltasone®, Cortan®, Sterapred®), a synthetic corticosteroid, is most often used to treat lupus. Others include hydrocortisone (Cortef®, Hydrocortone®), methylprednisolone (Medrol®), and dexamethasone (Decadron®).

Corticosteroids are available as a topical cream or ointment for skin rashes, as tablets, and in injectable form for intramuscular or intravenous administration.

Mechanism of Action and Use

The frequently prescribed corticosteroids are highly effective in reducing inflammation and suppressing the immune response. These drugs may be used to control exacerbation of symptoms and are used to control severe forms of the disease. These drugs are usually administered orally. During periods of serious illness or prior to surgery, they may be administered intravenously; once the patient has been stabilized (or patient is able to have oral fluids after surgery), oral administration should be resumed.

Possible Side Effects

These include changes in appearance (such as acne or increased facial hair); development of a round or moon-shaped face; thin, fragile skin that bruises easily; or movement of body fat to the trunk. You might also experience mood changes, personality changes, irritability, agitation, or depression.

Other possible side effects include increased appetite and weight gain, poor wound healing, headache, glaucoma, irregular menstrual periods, peptic ulcer, muscle weakness, osteoporosis, steroid-induced diabetes, and osteonecrosis (damage to a joint, usually the hip joint, that leads to severe arthritis).

Because corticosteroids cross the placenta, they are used cautiously during pregnancy. The drugs appear in breast milk, so if you are taking large doses, you should not breastfeed.

Side Effects by System:

  • Central Nervous System: depression, mood swings, and psychosis
  • Cardiovascular: congestive heart failure (CHF) and hypertension*
  • Endocrine: Cushing’s syndrome, menstrual irregularities, and hyperglycemia
  • Gastrointestinal: GI irritation, peptic ulcer, and weight gain
  • Dermatologic: thin skin, petechiae, ecchymoses, facial erythema, poor wound healing, hirsutism,* urticaria, and acne
  • Musculoskeletal: muscle weakness, loss of muscle mass, and osteoporosis*
  • Ophthalmologic: increased intraocular pressure, glaucoma, exophthalmos, and cataracts*
  • Other: immunosuppression and increased susceptibility to infection

Precautions

  • Avoid exposure to infections. Stay away from crowds and people known to have colds, the flu, or other infections.
  • Schedule regular vision checkups and report any problems with your vision to your doctor or nurse.
  • Talk with a registered dietitian to find out how to prevent excess weight gain and minimize certain drug effects on the body.
  • Do not take this drug with other drugs, including over-the-counter medications, without first checking with your nurse or doctor. Over-the-counter medications are medications that you can get without a doctor’s prescription.
  • Tell any nurse, doctor, or dentist who is taking care of you that you are taking a corticosteroid for your lupus.
  • WARNINGS! Do not take this drug if you have ever had an allergic reaction to it.
  • Carry medical identification and wear a bracelet to alert medical personnel that you take a corticosteroid. If you are planning to have a medical procedure, let the doctor performing the procedure know ahead of time that you take a corticosteroid. Your dose will likely need to be increased before the procedure.
  • NEVER MISS A DOSE: Take this drug exactly as ordered. If you do miss a dose, call your nurse or doctor immediately to find out when you should take the missed dose.
  • NEVER STOP THE MEDICATION SUDDENLY: Your adrenal glands, which are located just above your kidneys, normally make corticosteroids in small amounts. These corticosteroids are important for many body functions. When you take corticosteroid medication, your body begins to make much less than usual, or even stops completely. If you suddenly stop taking your medication, you may have a problem because your adrenal glands won’t have had time to make the corticosteroids you need. This problem is called “adrenal insufficiency.”
  • Signs of adrenal insufficiency include weakness, fatigue, fever, weight loss, vomiting, diarrhea, and abdominal pain. If you experience any of these problems, call your nurse or doctor immediately.
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