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
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
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
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
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.