Use of Corticosteroids Treatment for Lupus and Side Effects

Corticosteroids have immunosuppressive action and determine the inflammation generated by lupus to back off. They are used in moderate to severe cases.

They may be administered orally, intravenously, cutaneously, or as injections.

Prednisone may only temporary be used in high dose, then these doses are gradually decreased.

Small doses of corticosteroids are used for:

* Skin rashes that are severe; they are administered as creams, ointments, pills or shots for these cases. The disadvantage is that rash may recidivate after the interruption of the treatment.
* Skin rash, fever, fatigue, muscular or articular pain and many other problems NSAIDs or antimalarials fail to treat.

High doses of corticosteroids are used for extremely serious problems that menace the patient's life, such as:

* Vasculitis.
* Kidney problems.
* Inflammation of the brain that may generate seizures, confusion, coma or stroke.
* Inflammation of the heart (myocarditis), external coating of the heart (pericarditis), pleurisy or peritonitis.
* Anemia generated by destroyed red blood cells (hemolytic anemia) or a low number of platelets (thrombocytopenia).

Corticosteroids are in many cases extremely effective and bring an obvious improvement to the symptoms of SLE: they are able to maintain the function of damaged kidneys, so that dialysis or transplant is not necessary. In high doses, they ameliorate serious diseases of the kidneys and central nervous system and reduce the inflammation of the blood vessels and lungs. They also improve quickly low platelets count, which is called pulse therapy.

The disadvantage of these medications is the development of a series of side effects; some of these are serious. A high dose increases the risk, and so does long –term treatment. Some of their side effects are common to the lupus as it is the case with pain of the articulations and fatigue.

Frequent and reversible side effects generated by corticosteroids:

* Weight gain
* Easy bruising
* Hypertension
* Glaucoma
* Weakness of the muscles
* Gastritis and peptic ulcer
* Rounding of facial features
* Edema
* Fluctuating behavior, focusing problems, insomnia, euphoria and anxiety
* Possibility of immune suppression – generated infection
* Diabetes

Frequent and irreversible side effects of corticosteroids:

* Osteoporosis
* Damage of the arteries
* Excessive hair growth
* Stretch marks

Rare and irreversible side effects of corticosteroids:

* Cataracts
* Osteonecrosis, which represents softened or destroyed knees, hips, wrists pr articulations of the feet.

In case you are on long term corticosteroids treatment or on high doses, you must take 1200 – 1500 mg of calcium and 400 – 800 IU of vitamin D every day and also medications like risedronate or alendronate to prevent osteoporosis. This risk can also be reduced by weight – bearing physical exercises.

For persons that have as main lupus symptoms fever, fatigue or pain, it is recommendable to use antimalarials or NSAIDs instead of corticosteroids. Corticosteroids are usually administered in constant doses, prescribed to be taken daily or every other day. These doses should be sufficiently small to prevent side effects and high enough to manage lupus. Other treatment scheme involving corticosteroids may start from a high dose that will be gradually reduced when the symptoms are under control. In case of very severe side effects, they must be replaced with immunosuppressants or antimalarial.