The Effects of Lupus and Lupus Medications on Mood.Treating Lupus with Steroids : Johns Hopkins Lupus Center
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Treatment of lupus with corticosteroids
Prednisone used to treat lupus.Low Dose of Prednisone May be Better than Complete Withdrawal While Lupus is Inactive
Steroids are a group of chemicals that make up a large portion of the hormones in your body. One of these steroids, cortisone, is a close relative of cortisol, which the adrenal glands in your body make as a natural anti-inflammatory hormone. Synthetic cortisone medications are some of the most effective treatments for reducing the swelling, warmth, pain, and tenderness associated with the inflammation of lupus.
Cortisone usually works quickly to relieve these symptoms. However, cortisone can also cause many unwelcome side effects, so it is usually prescribed only when other medications—specifically NSAIDs and anti-malarials—are not sufficient enough to control lupus. However, it is important to remember that steroids make up a large group of molecules with different functions, and the steroids given to treat lupus—specifically, corticosteroids—are different than those you may hear about on the news.
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. Your body gets used to steroids. Do not stop them quickly. You should slowly cut down on the number of pills you take. Your doctor or nurse will explain how to do this. If you have one very painful joint, tendon or bursa, your doctor may give you a steroid shot injection into that area.
This will reduce your pain without side effects to your whole body. The most common side effects are feeling hungry, having an upset stomach, and feeling nervous. Steroids in higher doses greater than 10 milligrams a day or taken for longer than a few months can have more side effects.
You may put on weight, your muscles and bones may get weak, and your skin may get thinner and bruise more easily. Steroids can also raise your blood pressure, increase blood sugar level, cause cataracts, and change your mood and sleeping habits. Your chances of getting infections may go up if you take steroids.
Let your doctor know if you are planning any surgery. Your steroid dose may have to be changed to prepare for surgery. If you are likely to be on steroids for more than a few months, it is a good idea to wear a medical alert bracelet that says that you take steroids.
Read our easy-to-print PDF version of this fact sheet. Please note: This information is intended to complement, not replace, the advice and care you receive from medical and health professionals. For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.
Stay Informed. Connect with us. Lupus Medicines - Steroids. What kind of medicine are steroids? What do steroids do? How long do steroids take to work? How do steroids work? How do you to take steroids? Most steroids are taken as pills.
❾-50%}Lupus Steroid Treatment - Brigham and Women's Hospital - What are steroids, and why are they used to treat lupus?
Through direct signals to the nucleus mediated by the glucocorticoid receptor, exogenous glucocorticoids impact a broad array of cellular functions. DNA binding of the glucocorticoid receptor, depending upon the specific promoter to which the receptor binds, affects gene expression by recruiting transcription factors to the promoter or by interfering with the function of co-factors required for gene transcription.
Steroid effects on the adhesion functions and release of products by phagocytic cells are prompt, occurring within hours of administration.
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.
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. Get Involved. About Us. Donate Become an Advocate. What is lupus? Impact on Daily Life. Support Services. Ask a Health Educator. Find Support Near You. List of Financial Assistance Resources. Programs and Services. Anyone with lupus. Health care professionals.
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Whether triggered by the physical symptoms of the condition itself, or as a result of side effects of medications commonly administered to lupus patients, the effects of lupus can have a marked psychological impact on those who live with it. Lupus is a very complicated illness, and the various forms of the disease can affect people in different ways.
Occasionally, this unpredictability leads to confusion, distrust, and stress. Lupus is caused by an overactive immune system. Occasionally, however, there will be unpredictable effects of a medication. This presentation aims to explain the differences between the psychological effects of the condition and the medications used to treat it. Delays in diagnosis and the unpredictability of symptoms tend to frustrate patients and can reduce their confidence in their medical teams.
People with lupus are, therefore, faced with further uncertainty: Is their symptom related to lupus, or can it be chalked up to aging or a completely unconnected ailment? This uncertainty can lead people with lupus to worry that every symptom is a sign of SLE and to have problems believing their medical team when they say not to be concerned. Such uncertainty can also lead to vague, chronic worry about health and can interfere with the ability to make plans for the future. This clinical evidence is important in that some people might blame themselves for their lupus, believing that their stress might have caused the lupus.
Such a rationalization is very human and understandable, but the reality is that our understanding of the cause of lupus is incomplete but that it does appear that lupus is not caused by psychological factors. There is some biological evidence of links between stress and lupus flares.
Such research focuses on B and T suppressor cells, cytokines, and various types of antibodies. It should be noted, however, that these research findings are interesting but have not yet been shown to have clinical, practical relevance. While stress does not seem to be a primary cause for lupus, it is clear that lupus causes people stress through its physical effects, its related uncertainty, and the resulting worries about physical problems.
Lupus can directly affect thinking, mood, and personality. When it has these effects, it is called neuropsychiatric lupus. Symptoms of neuropsychiatric lupus include:. Steroids are often central to the treatment of lupus, but steroids such as prednisone can cause all of the symptoms of neuropsychiatric lupus. Because neuropsychiatric symptoms are common in SLE, terms have sprung up that are widely used but are also often inaccurate. In trying to distinguish the cause of neuropsychiatric symptoms, it is useful to recall that lupus is more likely to be the cause than steroids when:.
Those with lupus may wonder how their condition can directly and biologically cause problems with thinking and mood.
Often, there is a direct neurological involvement in lupus related to the autoimmune system. There remains controversy about how lupus affects the brain. Antineuronal antibodies antibodies against nerve tissue have been demonstrated, but it is not yet clear whether it these antibodies cause direct damage to the nerves.
We know that patients with lupus, on no steroids, can have depression, delirium, confusion, mistrust, and even psychosis. Anti-phospholipid antibodies are also present in some patients with lupus.
Many of these neuropsychiatric effects are reversible, and there is a much lower risk of developing these problems if a patient with lupus only has joint and skin involvement, if the patient is ANA-negative or if the illness is a the result of a medication, which can be withdrawn. People react to having lupus in different ways, and these reactions can change with time. Some of these reactions may include:. Feelings of pride, endurance, connection, appreciation, and maturity have also been commonly seen in people with lupus.
After opening the topic up for discussion in the workshop, it became immediately clear that everyone in the room had a different way to cope with - and improve - their own relationship with lupus. Advice from workshop members ranged from treating yourself to additional sleep, to your favorite food item, to a vacation, or a book, or a movie, or TV, or a visit to a favorite place to communicating with those who understand, or at least can empathize with — your struggle.
I had to tell myself not to obsess on the computer. Sit back. Get a different perspective. You may have your own tools, but you may find that the tools other people are using can help you as well.
Learn more about the HSS SLE Workshopa free support and education group held monthly for people with lupus and their families and friends. Stress Is lupus caused by stress? Symptoms of neuropsychiatric lupus include: Cognitive dysfunction : Refers to a variety of related experiences, including forgetfulness, worry, mistrust, and a general difficulty in thinking. These feelings are experienced by those without lupus as well, of course, and are perfect examples of the difficulty physicians face in diagnosing lupus.
Depression and anxiety : May occur as direct effect of the lupus, as a psychological reaction to the illness, or as a reaction to medications used to treat lupus. Mood symptoms also occur commonly in people without lupus, and so it is generally difficult to be certain about what causes depression and anxiety in people with lupus.
A personality change : This can refer to feelings of anger, irritability, and lability the sensation of not feeling or acting like yourself. The unpredictability of these changes makes it hard for some people with lupus to connect with those around them. They may even wonder if their communication problems are the result of their friends and loved ones reacting poorly to their condition Steroids Steroids are often central to the treatment of lupus, but steroids such as prednisone can cause all of the symptoms of neuropsychiatric lupus.
In trying to distinguish the cause of neuropsychiatric symptoms, it is useful to recall that lupus is more likely to be the cause than steroids when: It has been more than two weeks after an increase in prednisone The prednisone dose was less than 40 milligrams per day The emotional symptoms improve with additional steroids.
Biology of Neuropsychiatric Symptoms Those with lupus may wonder how their condition can directly and biologically cause problems with thinking and mood.
The Psychological Impact of SLE People react to having lupus in different ways, and these reactions can change with time. Some of these reactions may include: Grief Depression Anxiety Regression and reduced independence due to physical limitations, etc.
Isolation and social withdrawal due to unpredictable moods, a prominent rash, etc. Fears of worsening disease and disability Fears of cognitive problems, stroke, kidney failure, becoming a burden, etc.
Ways to Improve the Negative Effects of SLE After opening the topic up for discussion in the workshop, it became immediately clear that everyone in the room had a different way to cope with - and improve - their own relationship with lupus. In-person and virtual physician appointments. Book online. Departments and Services.
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Prednisone is the most common steroid that doctors use to treat lupus. If you have liver problems, your doctor may recommend different steroids. Prednisone at long course to avoid disease activity. While Prednisone is an effective and rapid anti-inflammatory agent in lupus, side effects. Corticosteroids, sometimes called simply “steroids,” usually work quickly to relieve pain, rashes, and swelling caused by lupus. But they have. The broad, generally suppressive effects of corticosteroids on the immune response render them useful for the management of most organ system manifestations of. Prednisone is the cortisone drug most frequently used. Cortisone and its derivatives are among the most effective anti-inflammatory drugs known. Use of these. Sit back. Other Ways to Give.Don't miss a thing. Subscribe to email for more resources. New research found that people with lupus whose disease is in remission for at least one year, and who are at high risk of relapse, benefit from a continued low dose 5mg. Complete withdrawal of Prednisone was associated with a fourfold increase in the risk of flare. Maintenance of the drug with inactive disease prevents relapse or flares. A group of people in remission on treatment were monitored, with 61 people receiving a maintained dose of 5mg.
Additionally, three people in the withdrawal group reported damage-related events osteoporosis-related fractures, retinal toxicity, cataract and zero events were recorded in the maintenance group.
An active disease-free state is generally maintained by long-term medications. However, the duration and dose of glucocorticoids GC , hydroxychloroquine HCQ and immunosuppressant IS therapy, after achievement of disease remission, remain undefined and it is only with medication tapering that the physician is able to determine whether the disease was truly in remission or maintained in remission as a result of medication," shared study author Zahir Amoura, MD, MSc.
This study provides further insight into glucocorticoids therapy and the possibility of continuing 5 mg. Prednisone at long course to avoid disease activity. While Prednisone is an effective and rapid anti-inflammatory agent in lupus, side effects of higher doses of the medication can be significant over time.
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