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Steroids

 

What are corticosteroids?

Corticosteroids are the chemicals commonly known as steroids.  They are normally produced by the cortex of the adrenal gland, which sits atop the kidneys & produces many chemicals. Corticosteroids give extra strength & power to the body in times of need. Corticosteroids are the strongest known anti-inflammatory drugs.

What steroids are available to treat lupus?

The most commonly used corticosteroid in lupus is prednisone.  Others are prednisolone (which is chemically changed for easy passage through the liver), hydrocortisone (weaker in strength than prednisone), methylprednisolone (stronger than prednisone), & dexamethasone (which is extremely potent & only used in unusual circumstances).

What symptoms of lupus can steroids be used to treat?

Patients who do not improve or are not expected to respond to NSAIDs or antimalarials, or those who have organ-threatening disease may be put on corticosteroids.  Steroids can be taken orally, used topically (for skin rashes), injected into the joints for arthritis, or given as an intravenous (IV) or intramuscular injection.

What are the side effects of steroids?

Weight gain, high blood pressure, thinning of the bones (osteoporosis), increased risk of diabetes, increased risk of infection, change in body shape (thin arms & legs, increase in size of the abdomen), poor sleep, increase in abdominal stretch marks, thinning of the skin, easy bruising, cataracts, steroid psychosis, depression, increase in facial hair & acne, avascular necrosis.

What doses of steroids are used in lupus?

Involvement of the heart, lungs, kidneys, liver or blood is managed with high dose steroids - between 40 to 80 milligrams a day. Severe flare-ups of non-organ threatening disease are treated with moderate doses - 20 to 40 milligrams a day. Chronic, mild, non-organ-threatening disease responds to daily doses of 2 to 20 milligrams a day.

Why is it important to reduce steroid intake gradually?

The function of the adrenal gland - a gland essential for life because it produces key hormones that regulate salt & water metabolism, & it is the source of adrenaline, "the fight or flight" hormone - is inhibited by large doses of corticosteroids & "turns off" when they are administered.  The gland can recover, but it needs time.  Therefore, stopping the drug suddenly results in no cortisone in the body.  This can be life-threatening.  Most patients get very ill if they mistakenly stop their steroid therapy abruptly.  When one reduces the prednisone dosage gradually, the adrenal gland gradually returns to full function.  Once full function returns, the drug can be completely discontinued.  Some individuals who have not been on the drug for very long (usually less than one month), or who have tapered off with sufficient care that their adrenal gland is back to normal, can come off the drug completely.

What can be done to minimise the side effects of steroids?

Keep to a low-sodium, low-fat, & low-carbohydrate diet & limit your calorie intake.  Diuretics can sometimes be prescribed to deal with bloating & fluid retention.  You should increase your intake of calcium & vitamin D, taking a supplement if necessary.  Keep active to minimise the risk of osteoporosis & muscle wasting.  If possible, stay away from relatives & friends who have colds or other infections.

What is pulse therapy?

Pulse therapy involves the administration of large amounts of corticosteroids over a short period of time, intravenously.  It is believed that the use of large doses (1000 mg at a time) can have a much more powerful effect on the body than small ones.  It may be used during a severe lupus flare, or in cases where there is danger to significant organs.
 
 

 

 
 

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