Lupus TreatmentA detailed guide to the types, uses high dose prednisone lupus potential side effects of the main medications used by people with lupus. Anti-inflammatory medications help to relieve many of the symptoms of lupus by reducing inflammation and pain. Anti-inflammatories are the most common drugs used to treat lupus, particularly symptoms such as fever, arthritis or does, which generally improve within several days of beginning treatment. For many people with lupus, an anti-inflammatory drug may be the only predniisone they need to control their lupus. Corticosteroids prescribed for autoimmune diseases are different from the anabolic steroids that weightlifters and other athletes sometimes take to increase strength.
Medications used to treat lupus
Steroids are a group of chemicals that make up a large portion of the hormones in your body. One of these steroids, cortisone, is a close relative of cortisol, which the adrenal glands in your body make as a natural anti-inflammatory hormone. Synthetic cortisone medications are some of the most effective treatments for reducing the swelling, warmth, pain, and tenderness associated with the inflammation of lupus.
Cortisone usually works quickly to relieve these symptoms. However, cortisone can also cause many unwelcome side effects, so it is usually prescribed only when other medications—specifically NSAIDs and anti-malarials—are not sufficient enough to control lupus.
However, it is important to remember that steroids make up a large group of molecules with different functions, and the steroids given to treat lupus—specifically, corticosteroids—are different than those you may hear about on the news. Corticosteroids help to slow and stop the processes in your body that make the molecules involved in your inflammatory response.
These steroids also reduce the activity of your immune system by affecting the function of cells in your blood called white blood cells. In reducing inflammation and immune response, corticosteroids help to prevent damage to the tissues in your body. Prednisone is the steroid most commonly prescribed for lupus. It is usually given as tablets that come in 1, 5, 10, or 20 milligram mg doses. Pills may be taken as often as 4 times a day or as infrequently as once every other day.
Usually, a low dose of prednisone is about 7. Your doctor may also prescribe a similar drug called prednisolone, especially if you have had any liver problems. Prednisolone and prednisone are very similar. In fact, the liver must convert prednisone to prednisolone before the body can use it. Sometimes lupus flares can be treated with an intra-muscular IM injection of a drug called Triamcinolone.
Usually, the only noticeable side effect of these injections is a dimple or loss of pigmentation at the injection sight.
Steroids can also be given intravenously IV in the form of methylprednisolone Solu-Medrol , and your doctor may prescribe higher doses of methylprednisolone mg given over day period.
These medications vary in potency. For example, hydrocortisone is weaker than prednisone, methylprednisolone is stronger, and dexamethasone is very potent. Ointments containing corticosteroids are also commonly prescribed for lupus rashes.
Steroid medications can have serious long-term side effects, and the risk of these side effects increases with higher doses and longer term therapy. For this reason, steroid medications are usually prescribed only after other less potent drugs have proven insufficient in controlling your lupus.
Your doctor will work with you to determine the lowest dose of steroids necessary to control your lupus symptoms and will prescribe steroids for the shortest possible amount of time. Steroids are sometimes combined with other drugs to help reduce some of these side effects. If you feel overwhelmed or frustrated with some of the outward effects of your medications, your doctor can help you to come up with some strategies to minimize side-effects.
However, it is important to realize that you play the most important role in helping yourself to stay as healthy as possible. There are many things you can do on a daily basis to help minimize the side effects of both steroid medications and your lupus symptoms.
A healthy diet is important for everyone, but it is especially important for people with lupus and those taking steroid medications. While taking steroids, your cholesterol, triglyceride, and blood sugar levels may increase. For these reasons, it is absolutely essential that you not increase your calorie intake and follow a low sodium, low-fat, and low-carbohydrate diet. You do not need to cut out all of the foods you love, but concentrate on eating whole grain breads and cereals and lean sources of protein such as chicken and fish.
If you need something to accompany your vegetables, try lighter dips like hummus. It is also important that you minimize alcohol intake when taking steroid medications, since steroids may already irritate your stomach.
In fact, it is best not to drink alcohol at all, because combining alcohol with certain lupus medications can be very harmful to your liver. Steroids may deplete certain vitamins in your body, such as vitamins C, D, and potassium. Your doctor may recommend for you to take supplemental vitamins or increase your intake of certain foods in order to make up for these deficiencies. Usually it is beneficial to take a multivitamin every day, but speak with your doctor to see which one is right for you, since some vitamins can adversely affect certain conditions.
For example, people with antiphospholipid antibodies, especially those taking anticoagulants such as warfarin Coumadin , should avoid vitamin K because it can increase the risk of blood clots.
Steroids can also contribute to a thinning of the bones known as osteoporosis, which may put you at an increased risk for bone fractures. Your doctor may prescribe a drug for osteoporosis or advise you to take a calcium or hormone supplement.
Bisphosphonates such as Actonel, Fosamax, and Boniva are commonly prescribed, as are parathyroid hormone Forteo and other medications. To help keep your bones as strong as possible, try to increase your intake of calcium and vitamin D. Calcium helps to keep bones strong and vitamin D helps your body make use of calcium.
Foods high in calcium include milk and milk products, tofu, cheese, broccoli, chard, all greens, okra, kale, spinach, sourkraut, cabbage, soy beans, rutabaga, salmon, and dry beans. In addition to increasing your risk of osteoporosis, steroid medications can weaken your muscles.
Staying as active as possible will help you to maintain strong muscles and bones. Weight-bearing activities such as walking, dancing, and running will help your muscles stay strong and healthy. Many people report that these activities make them feel better mentally as well. However, you should never put yourself through more than reasonable discomfort when exercising.
People with lupus should never smoke due to their increased risk of cardiovascular disease. Steroid medications increase this risk by upping blood pressure, triglycerides, and cholesterol.
Smoking, steroids, and lupus make a very bad combination. Steroid medications can also increase the risk of infection; this risk increases if you are also taking immunosuppressive drugs. For this reason, it is important that you try to avoid colds and other infections. Washing your hands regularly is perhaps the best way to keep germs at bay.
More serious infections can lead to serious—even fatal—illness. The infections that most worry doctors are kidney infection, a type of skin infection called cellulitis, urinary tract infections, and pneumonia.
It is important to be on the lookout for any changes in your health, because people taking steroids may not run a fever even though they are very ill. If these infections go untreated, they could enter the bloodstream and pose an even bigger threat, so it is important that you notify your doctor at the first signs of an infection or illness.
In addition, live virus vaccines, such as FluMist, the small pox vaccine, and the shingles vaccine Zostavax should be avoided because they may cause disease in individuals taking steroid medications. Finally, since medications can increase your risk of cataracts and aggravate glaucoma, try to get an eye exam twice a year. Notify your doctor of any major changes in your vision. You should not stop taking steroids abruptly if you have been taking them for more than 4 weeks.
Once your body has adjusted to taking steroids, your adrenal glands may shrink and produce less natural cortisone. Therefore, it is important to slowly reduce the dosage of steroids to allow the adrenal glands to gradually regain their ability to produce cortisone on their own.
Steroids are often given in high doses, which may increase the risk of side effects. However, as their name suggests, immunosuppressive work to suppress the immune system, so when taking these drugs, it is important to watch out for infection and notify your doctor at any sign of illness.
If you do acquire an infection, you may be prescribed an antibiotic or other medication, but be sure to stay away from Bactrim, since this medication can cause flares in some people with lupus.
Because of the risk of osteoporosis, your doctor may also prescribe a bisphosphonate such as Actonel, Fosamax, or Boniva. Your doctor may also prescribe a diuretic to deal with bloating, fluid retention, and hypertension high blood pressure.
In addition, since cortisone can cause elevated cholesterol, your doctor may prescribe statins such as Lipitor, Crestor, Vytorin, or Caduet. These medications work to lower cholesterol. About The Center Meet Dr. How do corticosteroids work to reduce inflammation in the body? What steroid medications are commonly prescribed for lupus? What are the side effects of steroid medications?
Possible side effects of taking these steroid medications are: Diabetes Glaucoma High blood pressure Increase in: Cholesterol Triglycerides May suppress growth in children Long term side effects: Avascular necrosis of bone death of bone tissue due to lack of blood supply: Usually associated with high doses of prednisone taken over long periods of time. Produces pain, including night pain. Pain relief usually requires either a core bone biopsy or total surgical joint replacement.
Occurs most often in hip, but can also affect shoulders, knees, and other joints. Osteoporosis Thinning of the bones. Can lead to bone fractures, especially compression fractures of vertebrae with severe back pain. Cataracts Glaucoma Muscle weakness Premature atherosclerosis — narrowing of the blood vessels by cholesterol fat deposits. Pregnancy complications —Doses of 20mg or more have shown to increase pregnancy and birth complications, such as preeclampsia.
What can I do to stay as healthy as possible while taking my steroid medications? Diet A healthy diet is important for everyone, but it is especially important for people with lupus and those taking steroid medications. Osteoporosis Steroids can also contribute to a thinning of the bones known as osteoporosis, which may put you at an increased risk for bone fractures. Staying Active In addition to increasing your risk of osteoporosis, steroid medications can weaken your muscles.
Smoking People with lupus should never smoke due to their increased risk of cardiovascular disease. Infection Steroid medications can also increase the risk of infection; this risk increases if you are also taking immunosuppressive drugs. Eye Exams Finally, since medications can increase your risk of cataracts and aggravate glaucoma, try to get an eye exam twice a year. Do not abruptly stop taking steroids You should not stop taking steroids abruptly if you have been taking them for more than 4 weeks.
Are there other drugs that I might take while taking steroids?