Steroids, specifically glucocorticoids, are a type of drug often used to reduce symptoms in people with lupus, along with antimalarials and NSAIDs. Some studies report that 80 percent of people with lupus take a low maintenance dose of steroids every day.1 People with very mild lupus may only take steroids during flares.
What are glucocorticoids?
Glucocorticoids (also known as corticosteroids, cortisone or steroids) are man-made versions of the corticosteroid hormones that your body naturally produces in the adrenal gland. These are the hormones your body produces in response to stress, especially cortisol. These hormones act as chemical messengers to regulate several body functions including blood pressure and the immune system.
Glucocorticoids are also used to relieve symptoms of other autoimmune diseases such as rheumatoid arthritis and multiple sclerosis.
How do steroids work to relieve the symptoms of lupus?
Steroids reduce inflammation by suppressing the immune system. In people with lupus, glucocorticoids are used to quickly reduce the swelling, soreness, and pain that comes with inflammation.
Glucocorticoids may be prescribed in pill form to help with systemic (whole-body) symptoms such as joint pain or swelling. Your doctor may give you a steroid cream to put on skin rashes and lesions that often come with lupus flares. Occasionally steroids will be injected directly into a muscle, joint or skin lesion to relieve symptoms.
Pulse steroids describe large intravenous (IV) doses given over several hours for three days in a row. Pulses usually are only given to people with severe active lupus who are in danger of permanent organ damage or death.2
IV glucocorticoids can relieve symptoms and control flares for weeks, so might be an option for people who cannot take steroids in pill form.
What are the potential side effects of taking glucocorticoids?
The pros and cons of taking steroids regularly for years are not fully understood. Some studies show little damage in the long-term use of low doses of steroids, and some tie long-term, low doses to delays in organ damage. Other studies suggest long-term use of any amount might be harmful.
The benefits of taking steroids, however, must be weighed with the many potential side effects known to result from long-term use, especially long-term use at high doses.
- Some common and rare side effects of taking steroids for years include:3,4
- Agitation and irritability
- Avascular necrosis (bone tissue death) in the hips and knees
- Blurred vision
- Cataracts or glaucoma
- Cushing’s syndrome (redistribution of body fat)
- Difficulty concentrating
- Facial hair growth in females
- Fast, irregular heartbeat or breathlessness
- Fluid retention
- Irreversible organ damage
- Raised blood pressure, blood sugar, cholesterol, or triglyceride levels
- Skin thinning
- Stomach upset and ulcers
- Trouble sleeping
- Trouble fighting off infections
- Weight gain due to increased appetite
These are not all the possible side effects of steroids. People taking steroids should talk to their doctor about what to expect with treatment.
Things to know about steroids
Prednisone is the most commonly prescribed steroid to fight the inflammation caused by lupus because of its low cost and relative safety. Prednisone is sold under many different brand names, including Millipred®, Sterapred®, Rayos®, Orapred®, Deltasone®, Prednicot®, Bubbli-Pred®, Cotolone®, and Flo-Pred®, to name a few.1,3,5
Prednisolone and methylprednisolone are similar drugs prescribed if someone cannot take prednisone, such as those with liver disease.
Steroids should not be taken at night to prevent insomnia (trouble sleeping).
Your doctor may prescribe antacids, proton pump inhibitors, or histamine H2 blockers to help reduce the chances of stomach ulcers.