Corticosteroids for lupus

Examples

Generic Name	Brand Name
betamethasone	Celestone
dexamethasone	Decadron, Hexadrol
hydrocortisone	Cortef, Hydrocortone
methylprednisolone acetate	Depo-Medrol, Medrol
prednisone

Some forms of steroids may be given intravenously, as pills, as an injection, or applied to the skin in a cream or ointment.

High doses of prednisone may be used for short periods of time; the dose is then gradually reduced.

How It Works

Corticosteroids suppress the immune system and reduce inflammation caused by lupus (systemic lupus erythematosus, or SLE).

Why It Is Used

Corticosteroids are used to control moderate to severe problems caused by lupus, including inflammation, pain, and tissue damage throughout the body.

Low-dose corticosteroids may be used to treat:

• Joint or muscle pain, skin rash, fatigue, fevers, and other symptoms that affect your quality of life and are not relieved by nonsteroidal anti-inflammatory drugs (NSAIDs) or antimalarials.
• Severe skin rashes, which may respond to steroid creams or ointments, shots, or pills. However, the skin symptoms may return when you stop using the steroid.

High-dose corticosteroids are used to treat severe or life-threatening problems including:¹

• Kidney disease.
• Inflammation of blood vessels (vasculitis).
• Inflammation of the heart (myocarditis), tissues around the heart (pericarditis), the tissue that lines the chest cavity (pleurisy), or the tissues surrounding the intestines (peritonitis).
• Anemia due to the destruction of red blood cells (hemolytic anemia) or low platelet count (thrombocytopenia).

High-dose corticosteroids can also ease central nervous symptoms such as severe headache, confusion, and nerve damage that causes problems with movement.¹

How Well It Works

Corticosteroids often dramatically improve many symptoms of lupus. Some conditions respond in as little as a few days, while others may take several weeks of corticosteroid therapy. The effects of corticosteroids can include:¹

• Decreased pain in joints and muscles.
• Decreased pain and inflammation from skin rashes.
• Decreased inflammation in blood vessels and in the tissues surrounding the heart and lungs.
• Decreased central nervous system symptoms, such as severe headaches and confusion.

Corticosteroids often work best for severe lupus when they are combined with other drugs such as mycophenolate mofetil, or cyclophosphamide with or without azathioprine.¹

Corticosteroids are prescribed and monitored carefully because they cause significant side effects.

Side Effects

Corticosteroids cause a wide variety of side effects, some of which can be severe. The risk of side effects is especially high when corticosteroids are taken in high doses for long periods of time. There are times when it can be difficult to distinguish between corticosteroid side effects and lupus symptoms, such as fatigue or joint pain.

Most common and reversible corticosteroid side effects:

• Swelling caused by fluid retention (edema)
• Weight gain
• Rounding of facial features
• Mood swings, difficulty concentrating, insomnia, anxiety, and euphoria
• Easy bruising
• Increased risk of infection from immune suppression
• Elevated blood pressure
• Gastritis, peptic ulcer
• Problems with blood sugar levels (diabetes)
• Muscle weakness
• Glaucoma

Common and irreversible corticosteroid side effects:

• Bone thinning and weakening (osteoporosis)
• Stretch marks (striae)
• Excessive hair growth
• Artery damage

Uncommon and irreversible corticosteroid side effects:

• Softening or destruction of the hip, knee, wrist, or foot joint (osteonecrosis)
• Cataracts

To prevent osteoporosis while taking long-term corticosteroids, take 1000 mg to 1500 mg of calcium daily, 400 IU to 800 IU of vitamin D daily, and consider a preventive medication, such as alendronate or risedronate. To come up with a plan that fits your needs, you may want to work with your doctor or a registered dietician. Weight-bearing exercise also helps reduce the risk of osteoporosis. For more information, see the topic Osteoporosis.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

If your main symptoms are pain, fatigue, or fever, many experts consider it best to avoid the side effects of steroids and try to control your symptoms with other medication, such as NSAIDs or antimalarials.

It is common to try to find a maintenance dose of steroids (taken daily or on alternate days) that is low enough to avoid serious side effects but high enough to control symptoms. You may start at a higher dose and then reduce the dose gradually after your symptoms have been controlled. If the dose that controls symptoms causes unacceptable side effects, another medication may also be used, such as an antimalarial or immunosuppressant.

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Author:	Shannon Erstad, MBA/MPH Ralph Poore	Last Updated: May 17, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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