- Lupus is a chronic medical condition that can lead to damage to any parts of the body such as joints or any organs.
- Steroids are synthetically processed prescription drugs, which are designed to work like the body’s naturally occurring hormones.
- Prednisone is the most commonly used steroid for the treatment of lupus.
What is lupus?
Lupus is known as a chronic autoimmune medical condition, which tends to damage any part of the body such as the skin, joints, or organs. The type of lupus we're talking about is systemic lupus erythematosus (SLE), which usually lasts for a longer duration from weeks to many years. When something goes wrong in the immune system, it can lead to lupus. The immune system helps protect the body against viruses, bacteria, or fungi, and the moment it is impaired, it paves the way for infections to develop. A healthy immune system produces proteins, which are known as antibodies. These antibodies help protect the body from harmful elements or foreign invaders.
Lupus is not a contagious disease. It doesn’t even spread through sexual contact. Moreover, lupus is not related to cancer. Lupus is an autoimmune disease and is not malignant like cancer. Lupus symptoms range from mild to moderate, but may also have life-threatening complications. Hence, people with lupus need careful medical attention for their treatment.
Steroids are also known as corticosteroids or cortisone. They are synthetically processed prescription drugs, which are designed in such a way that it works like the body’s naturally occurring hormones. These hormones are produced by the adrenal glands, and one of them, in particular, is cortisol. The main function of cortisol is to regulate blood pressure and the immune system. It is also known as the body’s most powerful anti-inflammatory hormone.
The use of steroids helps in reducing swelling, tenderness, warmth, and pain, which are all associated with inflammation. Steroids act by reducing or suppressing the response of the immune system. Steroids are mostly taken in the form of pills but they are also available in topical creams and gels when used for skin lupus. They are also available in the form of liquids, which are basically given as an injection into the muscles or joints. In some cases, steroid injections can be directly administered on skin lesions.
Steroid pulse therapy is usually given in large doses, and is given through vein injections. The effect of pulse steroids is mostly beneficial for several weeks. Hence, in some cases, doctors opt for pulse steroids to control lupus flare-ups or for those individuals who cannot tolerate the pill form of steroids.
The steroid dosage is initially kept at the lowest effective level. Later, if the doctor finds out that the symptoms of lupus are responding well to the treatment, then the dose of steroid can be gradually reduced. Moreover, as an alternative for reducing the dosage, the doctor can instead recommend alternating days of taking the medicine, wherein it should be one day on and one day off.
Common Steroid Medications
- Prednisone is one of the commonly preferred steroids for the treatment of lupus.
- Prednisolone and methylprednisolone are both similar to prednisone.
Prednisone (Rayos or Sterapred)
Prednisone is one of the commonly prescribed steroids for the treatment of lupus. It is used as an anti-inflammatory agent, and in some cases, as an immunosuppressive medication. Prednisone prevents the release of certain substances in the body that can lead to inflammation. It also suppresses the body’s response to the immune system. However, avoid taking prednisone if you have any kind of fungal infection. The reason behind it is that steroid medications are known to weaken the immune system, which can make the body vulnerable to infections. Hence, when you have an ongoing steroid therapy, you must avoid going out in crowded places or near sick people.
You should not also receive any immunization or live vaccinations during the course of treatment. Before you start with the treatment, inform the doctor if you are allergic to any of the contents present in prednisone or have food or medicine allergies. You should also let the doctor know if you are presently suffering from any kind of infection since the use of this medicine can worsen your existing condition. The doctor should know if you have the following conditions:
- Thyroid disorder
- High blood pressure
- Heart problems
- Potassium deficiency
- Past history of malaria
- Muscle disorders
- Mental illness such as depression
- Stomach ulcer
- History of stomach bleeding
Long-term use of prednisone can lead to the weakening of the bones. Talk to the doctor about the risk of developing osteoporosis. The doctor should know if you are pregnant, planning for pregnancy, or nursing a baby since this medicine can lead to certain defects in the baby. Steroids are known to cause a disruption in the growth of the child. Inform the doctor if you notice that your child is not growing properly.
Prednisone should be exactly taken as prescribed by the doctor or check the drug's label for the dosage and instructions. The doctor would keep on changing the dosage limit for best results, especially when improvements of the symptoms are observed. Do not take this medicine in larger doses. It is usually given in the form of a tablet, which is available in 1, 5, 10 or 20 mg doses. These pills can be taken as often as four times a day, or in some cases, just once a day. A low dose of prednisone comes to about 7.5 mg per day or less. A medium dose would range from 7.5-30 mg per day, whereas a high dose would be anything above 30 mg per day.
Moreover, prednisone should be taken along with food. If you happen to have a liver problem, then the doctor can also prescribe a similar kind of drug known as prednisolone. Both of these medications are quite similar. Actually, the liver has to convert prednisone to prednisolone before it is used by the body.
Do not crush or chew the tablet. It needs to be swallowed as a whole. While you are on prednisone, the doctor would regularly conduct blood tests and periodically check your blood pressure level. Do not suddenly stop taking this medicine since it can lead to withdrawal symptoms.
The common side effects of prednisone include:
- Severe form of depression
- Rapid weight gain
- Pain in the eye or vision problems
- Sleep problems or insomnia
- Excessive sweating
- Slow healing of wounds
- Mood changes
- Irregular heartbeat
- Frequent urge to urinate
- Nausea and vomiting
- Shortness of breath
There are certain medications that can also interact with prednisone, and they are St. John’s wort, birth control pills, cyclosporine, HIV or AIDS medicine, amphotericin B, and blood thinners.
Prednisolone (Millipred DP)
Prednisolone is a steroid, which works by modifying the immune response of the body to various conditions, leading to a decrease in inflammation. Do not take prednisolone if you are allergic to any of the contents of the medicine, if you have any systemic fungal infection, a history of malaria, an eye infection caused by herpes, and if you are taking mifepristone.
Before taking prednisolone, inform the doctor if you are pregnant, planning to get pregnant, or breastfeeding. You also have to inform the doctor if:
- You are currently taking prescription or non-prescription drugs
- If you have certain allergies to food or medicine
- If you have a history of heart disease and high blood pressure
- If you have recently contracted bacterial, fungal, or viral infections.
Certain medications can also interact with prednisolone, and they include anticoagulants, which affect the effectiveness of prednisolone. The side effects of prednisolone can increase with the use of the following drugs:
- Oral contraceptives
The effectiveness of prednisolone can be decreased due to the use of the following medications:
Prednisolone should be used as advised by the doctor. You can also check the medicine's label for dosing instructions. Prednisolone should be taken orally with food.
The common side effects of prednisolone include the following:
- Discomfort in the body
- Increased appetite
- Excessive sweating
- Stomach upset
The drug's severe side effects include:
- Allergic reactions
- Frequent urination
- Mood changes
- Severe vomiting
- Swelling of the ankles, feet, or hands
- Pain in the bone or tendons
- Unusual skin sensations
- Sudden weight gain
- Muscle pain
- Black stools
- Menstrual cycle changes
Methylprednisolone (Medrol or Medrol Dosepak)
Methylprednisolone comes in the form of a tablet, which has to be taken only with prescription from the doctor. It is also available in the form of generic drugs. However, these types of drugs are not usually available in every strength or form. Methylprednisolone can also be prescribed in the form of suspension or solution.
Methylprednisolone is used to treat a lot of medical conditions since it helps control the inflammation in the body and also modifies the immune system. Methylprednisolone is a part of the glucocorticoid class of drugs. The main purpose of these drugs is to reduce the inflammation by altering the immune system of the body, which then leads to a reduction in the inflammation.
The effects of methylprednisolone can also lead to liver damage. However, it can be reversed once the person stops taking the medication. The most common side effects of methylprednisolone are feeling of confusion, excitement,
- Feeling confused or excited
- Sudden gain in weight
- Swelling of the ankles, feet, or hands
- Increased thirst
- Increased risk of infections
- Weakness and fatigue
If these side effects are moderately mild, then they would go away in a couple of days or weeks. If it gets severe, then consult the doctor right away. The following are serious side effects of methylprednisolone:
- Allergies that lead to skin rashes
- Swelling of the face, lips, or tongue
- Sudden mood changes
- Anxiety and personality changes
- Vision problems
- Frequent urge to urinate
- Coughing and sore throat
- Loss of appetite
- Skin irritation
Individuals taking methylprednisolone should avoid drugs such as cyclosporine, troleandomycin, and ketoconazole because these medicines can cause drug interactions. Drugs such as phenytoin, phenobarbital, and rifampin can also lead to a decrease in methylprednisolone's effectiveness.
How do steroids help?
The body naturally responds to any foreign invasion, injury, or infection through the process of inflammation. However, for individuals who are diagnosed with lupus, the body’s immune system does not normally function as it is supposed to. This abnormal functioning then leads to an inflammatory response by causing damage to its own tissues, which leads to side effects such as stiffness, warmth, tenderness, and pain in various parts of the body.
With the help of steroids, such process is slowed down or stopped. However, steroids are also known to reduce or suppress the activity of the immune system by causing an impact on the functioning of the white blood cells. Thus, in reducing the inflammation as well as the immune response, steroids can help prevent any damage to the tissues.
The common side effects of steroids are mentioned below. However, if the side effects tend to get worse over time, then inform your doctor immediately.
- Delayed growth and development of children
- Easy bruising
- Retention of fluid in the body
- Easily irritated
- Agitated or aggressive
- Weight gain
- Hair growth
- Lack of sleep or insomnia
- Mental changes leading to depression
Larger doses of steroids can lead to changes in the appearance as well as the mood of the individual.