Medication can help manage your symptoms and assist in controlling your overactive immune system. You might need to take a combination of different medications that could include:. Usually taken as one or two tablets daily, hydroxychloroquine reduces the skin and joint problems associated with lupus. People who take hydroxychloroquine are less likely to have lupus flares, so most rheumatologists recommend that it be taken by all people with lupus for the long term.
Side effects of anti-malarial medications are uncommon. Occasionally, they can cause a rash or stomach upsets including diarrhoea. If the dose is too high, they can cause eye damage, but this is extremely rare when the correct dose is used. However, annual eye checks are recommended. Corticosteroids, also known as steroids, cortisone, prednisone and prednisolone, are synthetic hormones that mimic the action of cortisone, a naturally occurring hormone produced by the adrenal glands. These medications are usually taken in tablet form, but may be injected for a particularly severe lupus flare.
The main function of steroids is to treat inflammation. They also help to reduce pain and fever. Steroids also dampen the activity of the immune system, which will help to reduce the severity of your symptoms. The main problem with steroids is that they have significant side effects. The potential side effects of corticosteroids include:. While these side effects sound bad, most people using steroids to manage lupus end up using very low doses with minimal side effects, even if their initial dose is high.
The difference between well-controlled lupus and lupus that is affecting your health can be a few milligrams of steroids — so avoiding them at all costs is not recommended. Lupus symptoms are triggered by the abnormal activity of the immune system, the specialised group of cells and chemicals that fight infection. Immunosuppressants such as azathioprine, cyclophosphamide and methotrexate reduce lupus symptoms by lowering immune system activity.
Azathioprine is used to treat lupus and is also used in the management of other immune diseases and organ transplantation. Methotrexate is a very commonly used medication in rheumatoid arthritis and is regarded as so safe that it is now the standard treatment. Mycophenolate is increasingly used, especially to treat lupus kidney disease.
Each of these medications has particular effects on lupus and particular side effects, so each should be used under close specialist supervision. Some lupus medications can interact dangerously with other medications. Other medications and supplements may interfere with your lupus medication or cause you to experience side effects. Studies suggest that people who are well-informed manage their condition better. Information sheets on the medications used in the management of lupus are available from the Australian Rheumatology Association or from your doctor or pharmacist.
Try to make sure you take your medications as prescribed, in the correct doses, and at the advised time of day. This page has been produced in consultation with and approved by:. Myalgic encephalomyelitis, commonly known as chronic fatigue syndrome, can affect people of any age, including children. Type 1 diabetes can affect anyone of any age, but is more common in people under 30 years.
Fluid retention oedema occurs when fluid isn't removed from the body tissues, including the skin. Causes include the body's reaction to hot weather, a high salt intake, and the hormones associated with the menstrual cycle. Symptoms include swelling of body parts such as feet, hands and ankles, a feeling of stiffness or aching and weight fluctuations.
Drinking plenty of water will actually help your kidneys to flush out excess fluid. Fluid retention may be a sign of disease. Henoch-Schonlein purpura causes a purple spotted skin rash which lasts around one to four weeks, and is often marked by relapses. Content on this website is provided for information purposes only. Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.
The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances.
Weight-bearing activities such as walking, dancing, and running will help your muscles stay strong and healthy. Many people report that these activities make them feel better mentally as well. However, you should never put yourself through more than reasonable discomfort when exercising.
People with lupus should never smoke due to their increased risk of cardiovascular disease. Steroid medications increase this risk by upping blood pressure, triglycerides, and cholesterol. Smoking, steroids, and lupus make a very bad combination. Steroid medications can also increase the risk of infection; this risk increases if you are also taking immunosuppressive drugs. For this reason, it is important that you try to avoid colds and other infections.
Washing your hands regularly is perhaps the best way to keep germs at bay. More serious infections can lead to serious—even fatal—illness. The infections that most worry doctors are kidney infection, a type of skin infection called cellulitis, urinary tract infections, and pneumonia. It is important to be on the lookout for any changes in your health, because people taking steroids may not run a fever even though they are very ill. If these infections go untreated, they could enter the bloodstream and pose an even bigger threat, so it is important that you notify your doctor at the first signs of an infection or illness.
In addition, live virus vaccines, such as FluMist, the small pox vaccine, and the shingles vaccine Zostavax should be avoided because they may cause disease in individuals taking steroid medications. Finally, since medications can increase your risk of cataracts and aggravate glaucoma, try to get an eye exam twice a year. Notify your doctor of any major changes in your vision. You should not stop taking steroids abruptly if you have been taking them for more than 4 weeks.
Once your body has adjusted to taking steroids, your adrenal glands may shrink and produce less natural cortisone. Therefore, it is important to slowly reduce the dosage of steroids to allow the adrenal glands to gradually regain their ability to produce cortisone on their own. Steroids are often given in high doses, which may increase the risk of side effects.
However, as their name suggests, immunosuppressive work to suppress the immune system, so when taking these drugs, it is important to watch out for infection and notify your doctor at any sign of illness. If you do acquire an infection, you may be prescribed an antibiotic or other medication, but be sure to stay away from Bactrim, since this medication can cause flares in some people with lupus. Because of the risk of osteoporosis, your doctor may also prescribe a bisphosphonate such as Actonel, Fosamax, or Boniva.
Your doctor may also prescribe a diuretic to deal with bloating, fluid retention, and hypertension high blood pressure. In addition, since cortisone can cause elevated cholesterol, your doctor may prescribe statins such as Lipitor, Crestor, Vytorin, or Caduet. These medications work to lower cholesterol. All information contained within the Johns Hopkins Lupus Center website is intended for educational purposes only.
Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website. How do corticosteroids work to reduce inflammation in the body?
What steroid medications are commonly prescribed for lupus? What are the side effects of steroid medications? Produces pain, including night pain. Pain relief usually requires either a core bone biopsy or total surgical joint replacement. Occurs most often in hip, but can also affect shoulders, knees, and other joints. Osteoporosis Thinning of the bones.
Can lead to bone fractures, especially compression fractures of vertebrae with severe back pain. Cataracts Glaucoma Muscle weakness Premature atherosclerosis — narrowing of the blood vessels by cholesterol fat deposits. Pregnancy complications —Doses of 20mg or more have shown to increase pregnancy and birth complications, such as preeclampsia.
What can I do to stay as healthy as possible while taking my steroid medications? Diet A healthy diet is important for everyone, but it is especially important for people with lupus and those taking steroid medications. Osteoporosis Steroids can also contribute to a thinning of the bones known as osteoporosis, which may put you at an increased risk for bone fractures. Staying Active In addition to increasing your risk of osteoporosis, steroid medications can weaken your muscles.
Smoking People with lupus should never smoke due to their increased risk of cardiovascular disease. Infection Steroid medications can also increase the risk of infection; this risk increases if you are also taking immunosuppressive drugs. Eye Exams Finally, since medications can increase your risk of cataracts and aggravate glaucoma, try to get an eye exam twice a year. Do not abruptly stop taking steroids You should not stop taking steroids abruptly if you have been taking them for more than 4 weeks.
Are there other drugs that I might take while taking steroids?
Psychosis and seizures are usually easy to diagnose and respond well to antipsychotics or anticonvulsants, as well as to corticosteroid treatment for systemic lupus erythematosus. However, many patients with systemic lupus erythematosus present with cognitive function difficulties, making it a challenge for the physician to differentiate between what is related to active lupus erythematosus, what is related to corticosteroid treatment, and what may be related to depression or chronic fatigue syndrome.
Fibromyalgia, a musculoskeletal syndrome characterized by generalized pain, fatigue and a variety of associated symptoms, is found in as many as 30 percent of patients with systemic lupus erythematosus and is frequently associated with chronic fatigue. Patients with central nervous system manifestations of lupus erythematosus who present with status epilepticus, organic brain syndrome or coma can be treated with intravenous methylprednisolone pulse therapy.
However, it is usually necessary to rule out other conditions that may mimic central nervous system manifestations of systemic lupus erythematosus, including infection and toxic metabolic states. One of the major complications of systemic lupus erythematosus is premature or accelerated atherosclerosis Table 7. This complication is one of the causes of later mortality, in the perimenopausal and early postmenopausal years.
It is also a major cause of morbidity. Studies conducted worldwide have suggested that somewhere between 6 and 10 percent of patients with systemic lupus erythematosus have clinically recognized premature atherosclerosis. The pathogenesis of premature atherosclerosis is almost certainly multifactorial and includes direct effects of the disease and side effects of treatment.
Longitudinal regression analyses 14 have shown that increasing the dosage of prednisone increases serum cholesterol, weight and blood pressure. Patients with systemic lupus erythematosus have higher levels of homocysteine, a known risk factor for atherosclerosis. Corticosteroid treatment increases the levels of cardiovascular risk factors, including weight, blood pressure, cholesterol and homocysteine levels.
Antiphospholipid antibody syndrome is one of the most common causes of acquired hypercoagulability in the general population and is much more common in patients with systemic lupus erythematosus Table 8. About one half of patients with systemic lupus erythematosus make antiphospholipid antibodies, including anticardiolipin antibody and lupus anticoagulant.
These antibodies often fluctuate over time, as does disease activity in general. Patients who have antiphospholipid antibodies have an increased risk of antiphospholipid antibody syndrome, a hypercoagulable state that can present with venous thrombosis, arterial thrombosis, recurrent pregnancy loss or thrombocytopenia.
The two clinically important antiphospholipid antibodies are lupus anticoagulant and anticardiolipin antibody. Presentations of antiphospholipid antibody syndrome include thrombosis, recurrent or late pregnancy loss, and thrombocytopenia. Long-term management of patients who have had a thrombotic event resulting from antiphospholipid antibody syndrome includes high-intensity warfarin Coumadin therapy INR of 3 to 4. The diagnosis of antiphospholipid antibody syndrome requires one of the four clinical presentations mentioned previously and the presence of either lupus anticoagulant or moderate- or high-titer anticardiolipin antibody.
In patients with systemic lupus erythematosus, the presence of lupus anticoagulant appears to be more specific for the syndrome than the presence of anticardiolipin antibodies, 16 but high-titer anticardiolipin antibody of the IgG or IgM class is also a risk factor. Patients with systemic lupus erythematosus who have already had a manifestation of antiphospholipid antibody syndrome require treatment. Patients who have had venous or arterial thrombosis appear to benefit from maintenance therapy with high-intensity International Normalized Ratio of 3 to 4 warfarin Coumadin.
Anemia in patients with systemic lupus erythematosus is most often associated with chronic disease or is related to iron deficiency. Classic autoimmune hemolytic anemia can present acutely and severely or as a chronic condition. Severe hemolytic anemia is treated initially with intravenous methylprednisolone, 1, mg per day for three days.
Leukopenia, which frequently occurs in patients with systemic lupus erythematosus, is usually not severe i. Severe, life-threatening thrombocytopenia is treated with high-dose intravenous methylprednisolone but may also require intravenous immunoglobulin therapy. The long-term management of patients with severe thrombocytopenia may also include danazol Danocrine , vincristine Oncovin , immunosuppressive drugs and, in rare instances, splenectomy.
Twenty years ago, women with systemic lupus erythematosus were often told not to become pregnant. Today, most women with lupus erythematosus can have a successful pregnancy, although the potential for maternal and fetal complications does exist Table 9. Patients who require warfarin or cyclophosphamide therapy should not become pregnant because of the teratogenic potential of these drugs. Some patients with lupus erythematosus who have the anti-Rh o and anti-La antibodies do have a higher risk of congenital heart block in the fetus.
Patients with antiphospholipid antibody syndrome have an increased risk of pregnancy loss and may require heparin and low-dose aspirin therapy to have a successful pregnancy. Patients with active lupus erythematosus and renal disease, or those who require higher dosages of prednisone greater than 20 mg per day have an increased risk of preterm birth.
Early losses are usually due to active lupus erythematosus or unknown factors. Second- or third-trimester losses are usually due to antiphospholipid antibody syndrome. Mother usually has both anti-Rh o and anti-La antibodies.
Most babies survive, but some have important morbidity. Monitoring the next pregnancy with serial four-chamber fetal echocardiograms may allow early detection of fetal heart block. Risk factors include active lupus erythematosus, maintenance therapy using prednisone dosages of more than 20 mg daily, renal disease and hypertension.
Increased risk of premature rupture of the membranes. Pre-eclampsia may be difficult to differentiate from renal flare caused by systemic lupus erythematosus. Already a member or subscriber? Log in. Michelle Petri, M. Petri received a medical degree from Harvard Medical School, Boston. After training in internal medicine at Massachusetts General Hospital, Boston, she completed fellowships in rheumatology, and allergy and immunology at the University of California, San Francisco, School of Medicine.
Address correspondence to Michelle Petri, M. Monument St. Reprints are not available from the author. Scopelitis E. Systemic lupus erythematosis. In: Hurst JW, ed. Medicine for the practicing physician. Boston: Butterworth-Heinemann, Clin Immunol Immunopathol. Fessel WJ. Systemic lupus erythematosus in the community. Incidence, prevalence, outcome, and first symptoms; the high prevalence in black women.
Arch Intern Med. Surface blebs on apoptotic cells are sites of enhanced procoagulant activity: implications for coagulation events and antigenic spread in systemic lupus erythematosus. The revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. Gladman D, et al. Guidelines for the management of systemic lupus erythematosus in adults. In press. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial.
Ann Intern Med. Petri M. Musculoskeletal complications of systemic lupus erythematosus in the Hopkins Lupus Cohort: an update. Arthritis Care Res. Progression of avascular necrosis AVN of the femoral head in systemic lupus erythematosus: long-term follow-up report.
Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Risk factors for coronary artery disease in patients with systemic lupus erythematosus.
Am J Med. Effect of prednisone and hydroxychloroquine on coronary artery disease risk factors in systemic lupus erythematosus: a longitudinal data analysis. Plasma homocysteine as a risk factor for atherothrombotic events in systemic lupus erythematosus. The frequency of lupus anticoagulant in systemic lupus erythematosus.
A study of 60 consecutive patients by activated partial thromboplastin time, Russell viper venom time, and anticardiolipin antibody level. The management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med. Repeated fetal losses associated with antiphospholipid antibodies: a collaborative randomized trial comparing prednisone with low-dose heparin treatment. Am J Obstet Gynecol. The Hopkins Lupus Pregnancy Center: — update. Am J Reprod Immunol.
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Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Assessment and Treatment of Bulimia Nervosa. Jun 1, Issue. Systemic lupus erythematosus predominantly affects women and is more common in blacks.
TABLE 5 Characteristics of Lupus Nephritis Occurs in approximately 50 percent of patients with systemic lupus erythematosus More common in black people Renal biopsy can be helpful in identifying the activity of lupus nephritis and the degree of chronicity scarring Cyclophosphamide Cytoxan is more effective than corticosteroids alone for the treatment of severe forms of lupus nephritis diffuse proliferative glomerulonephritis.
TABLE 7 Characteristics of Premature Atherosclerosis Present in 6 to 10 percent of patients with systemic lupus erythematosus Associated with duration of disease Corticosteroid treatment increases the levels of cardiovascular risk factors, including weight, blood pressure, cholesterol and homocysteine levels. TABLE 9 Pregnancy-Associated Complications in Women with Systemic Lupus Erythematosus Pregnancy loss Early losses are usually due to active lupus erythematosus or unknown factors Second- or third-trimester losses are usually due to antiphospholipid antibody syndrome Congenital heart block Mother usually has both anti-Rh o and anti-La antibodies Most babies survive, but some have important morbidity Monitoring the next pregnancy with serial four-chamber fetal echocardiograms may allow early detection of fetal heart block Preterm birth Risk factors include active lupus erythematosus, maintenance therapy using prednisone dosages of more than 20 mg daily, renal disease and hypertension Increased risk of premature rupture of the membranes Pre-eclampsia may be difficult to differentiate from renal flare caused by systemic lupus erythematosus.
Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. The Author Michelle Petri, M. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Corticosteroids help to slow and stop the processes in your body that make the molecules involved in your inflammatory response.
These steroids also reduce the activity of your immune system by affecting the function of cells in your blood called white blood cells. In reducing inflammation and immune response, corticosteroids help to prevent damage to the tissues in your body. Prednisone is the steroid most commonly prescribed for lupus. It is usually given as tablets that come in 1, 5, 10, or 20 milligram mg doses. Pills may be taken as often as 4 times a day or as infrequently as once every other day.
Usually, a low dose of prednisone is about 7. Your doctor may also prescribe a similar drug called prednisolone, especially if you have had any liver problems. Prednisolone and prednisone are very similar. In fact, the liver must convert prednisone to prednisolone before the body can use it. Sometimes lupus flares can be treated with an intra-muscular IM injection of a drug called Triamcinolone.
Usually, the only noticeable side effect of these injections is a dimple or loss of pigmentation at the injection sight. Steroids can also be given intravenously IV in the form of methylprednisolone Solu-Medrol , and your doctor may prescribe higher doses of methylprednisolone mg given over day period. These medications vary in potency.
For example, hydrocortisone is weaker than prednisone, methylprednisolone is stronger, and dexamethasone is very potent. Ointments containing corticosteroids are also commonly prescribed for lupus rashes. Steroid medications can have serious long-term side effects, and the risk of these side effects increases with higher doses and longer term therapy.
For this reason, steroid medications are usually prescribed only after other less potent drugs have proven insufficient in controlling your lupus. Your doctor will work with you to determine the lowest dose of steroids necessary to control your lupus symptoms and will prescribe steroids for the shortest possible amount of time. Steroids are sometimes combined with other drugs to help reduce some of these side effects.
If you feel overwhelmed or frustrated with some of the outward effects of your medications, your doctor can help you to come up with some strategies to minimize side-effects. However, it is important to realize that you play the most important role in helping yourself to stay as healthy as possible. There are many things you can do on a daily basis to help minimize the side effects of both steroid medications and your lupus symptoms. A healthy diet is important for everyone, but it is especially important for people with lupus and those taking steroid medications.
While taking steroids, your cholesterol, triglyceride, and blood sugar levels may increase. For these reasons, it is absolutely essential that you not increase your calorie intake and follow a low sodium, low-fat, and low-carbohydrate diet. You do not need to cut out all of the foods you love, but concentrate on eating whole grain breads and cereals and lean sources of protein such as chicken and fish.
If you need something to accompany your vegetables, try lighter dips like hummus. It is also important that you minimize alcohol intake when taking steroid medications, since steroids may already irritate your stomach. In fact, it is best not to drink alcohol at all, because combining alcohol with certain lupus medications can be very harmful to your liver.
Steroids may deplete certain vitamins in your body, such as vitamins C, D, and potassium. Your doctor may recommend for you to take supplemental vitamins or increase your intake of certain foods in order to make up for these deficiencies.
Usually it is beneficial to take a multivitamin every day, but speak with your doctor to see which one is right for you, since some vitamins can adversely affect certain conditions. For example, people with antiphospholipid antibodies, especially those taking anticoagulants such as warfarin Coumadin , should avoid vitamin K because it can increase the risk of blood clots. Steroids can also contribute to a thinning of the bones known as osteoporosis, which may put you at an increased risk for bone fractures.
Your doctor may prescribe a drug for osteoporosis or advise you to take a calcium or hormone supplement. Bisphosphonates such as Actonel, Fosamax, and Boniva are commonly prescribed, as are parathyroid hormone Forteo and other medications. To help keep your bones as strong as possible, try to increase your intake of calcium and vitamin D.
Calcium helps to keep bones strong and vitamin D helps your body make use of calcium. Foods high in calcium include milk and milk products, tofu, cheese, broccoli, chard, all greens, okra, kale, spinach, sourkraut, cabbage, soy beans, rutabaga, salmon, and dry beans. In addition to increasing your risk of osteoporosis, steroid medications can weaken your muscles. Staying as active as possible will help you to maintain strong muscles and bones.
Weight-bearing activities such as walking, dancing, and running will help your muscles stay strong and healthy. Many people report that these activities make them feel better mentally as well. However, you should never put yourself through more than reasonable discomfort when exercising. People with lupus should never smoke due to their increased risk of cardiovascular disease. Steroid medications increase this risk by upping blood pressure, triglycerides, and cholesterol.
Smoking, steroids, and lupus make a very bad combination.
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|Steroid tablets for lupus||Advocacy for Research. NSAIDs, such as ibuprofen Motrin, Advilnaproxen NaprosynCelecoxib Celebrexdiclofenac Voltarenand indomethacin Indocinamong many others, are prescribed for a variety of rheumatic diseases including systemic lupus. Immunosuppressive drugs. Benlysta is also approved to treat lupus nephritis in adults and children over 5. Henoch-Schonlein purpura causes a purple spotted skin rash which lasts around one to four weeks, and is often marked by relapses. The management of thrombosis in the antiphospholipid-antibody syndrome.|
|Steroid tablets for lupus||In press. TABLE 7 Characteristics of Premature Atherosclerosis Present in 6 to 10 percent of patients with systemic lupus erythematosus Associated with duration of disease Steroid equivalent supplement treatment increases the levels of cardiovascular risk factors, including weight, blood pressure, cholesterol and homocysteine levels. It may take a few weeks or months to determine the right combination for you. Because systemic lupus erythematosus is a chronic disease, patients require extensive health education in terms of their responsibility in managing their condition. Blood thinners can cause bleeding that is difficult to control.|
|Steroid tablets for lupus||Corticosteroids, also known as steroids, cortisone, prednisone and prednisolone, are synthetic hormones that mimic the action of cortisone, a naturally occurring hormone produced by the adrenal glands. More serious infections can lead to serious—even fatal—illness. In press. Cyclophosphamide Cytoxan is more effective than corticosteroids alone for the treatment of severe forms of lupus nephritis diffuse proliferative glomerulonephritis. Acthar Gel has similar side effects as steroid medicines. How long do steroids take to work?|
|Steroid tablets for lupus||In addition to increasing your risk of osteoporosis, steroid medications can weaken your muscles. Do not abruptly stop taking steroids Uk steroids buy should not stop taking steroids abruptly if you have been taking them for more than 4 weeks. Methotrexate Rheumatrex or azathioprine Imuran is used as steroid-sparing drug. You should not receive more than injections a year into the same areas. The most serious possible complication is damage to the eyes, although this is very uncommon.|
|Franklin mint gold silver dragon pocket watch||NSAIDs, such as ibuprofen Motrin, Advilnaproxen NaprosynCelecoxib Celebrexdiclofenac Voltarenand indomethacin Indocinamong many others, are prescribed for a variety of rheumatic diseases including systemic lupus. Talk to your doctor about side effects. The diagnosis of antiphospholipid antibody syndrome requires one of the four clinical presentations mentioned previously and the presence of either lupus anticoagulant or moderate- or high-titer anticardiolipin antibody. Am J Obstet Gynecol. Most people with systemic lupus erythematosus SLE will need to take medication — often a combination of drugs — as part of their treatment at least some of the time.|
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