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Corticosteroids for Lupus

Examples

Generic Name Brand Name
betamethasone Celestone
dexamethasone  
hydrocortisone Cortef
methylprednisolone Depo-Medrol, Medrol
prednisone  

Depending on the drug, 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. But the skin symptoms may return when you stop using the steroid.

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

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

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.1

The effects of corticosteroids can include:

  • 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 are often combined with other drugs such as mycophenolate mofetil, or cyclophosphamide with or without azathioprine.

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

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.
  • Signs of an infection, such as a sore throat, fever, sneezing, or coughing.
  • Belly pain, nausea, or vomiting that won't go away.
  • Bloody or black, tarry stools.
  • Rapid weight gain.
  • Changes in your eyes, including blurred vision or eye pain.
  • Muscle cramps, pain, or weakness.
  • Changes in skin, including acne or reddish purple lines.
  • Increased thirst, especially with frequent urination.

Common side effects of this medicine include:

  • Increased appetite.
  • Nervousness or restlessness.

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

What To Think About

Corticosteroids can keep your immune system from fighting infection. When you are taking this medicine (and even after you stop taking it), try not to be around people who are sick. And make sure you talk to your doctor before you get any vaccinations.

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.

To prevent osteoporosis while taking long-term corticosteroids, get plenty of calcium and vitamin D, and consider a preventive medicine, 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 dietitian. Weight-bearing exercise also helps reduce the risk of osteoporosis. For more information, see the topic Osteoporosis.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Women who use this medicine during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Crow MK (2008). Systemic lupus erythematosus. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 23rd ed., pp. 2022–2032. Philadelphia: Saunders Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
Last Revised May 10, 2012

Last Revised: May 10, 2012

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology

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