Corticosteroids, also called steroids, are a mainstay in the fight against lupus. Corticosteroids are actually hormonal drugs that behave like the body’s own adrenal gland hormone adrenaline. These synthetic versions are very powerful and the doses given are much greater than the body can produce on its own. Don't confuse corticosteroids with the anabolic steroids often abused by athletes. Corticosteroids affect lupus because they suppress the overactive immune system and inflammation contributing to the flares that may cause tissue damage. Unfortunately, these strong drugs have side effects and consequences that all lupus patients must discuss with their physicians before starting therapy. An immunosuppressed patient often suffers infections, such as strep throat, UTIs, or even a reactivated infection like herpes (shingles) or TB. There are many side effects of corticosteroids including high blood pressure, calcium loss, GI irritation and ulcers (thrush/ yeast infections), delayed wound healing, menstrual irregularities, increased appetite and weight gain, hair growth, especially on arms, face and legs, fat deposits on face and upper body (Also called “moonface” and “buffalo hump”). Long term use and high doses can lead to some secondary health conditions such as hypertension, osteoporosis, exogenic Cushing's syndrome, cataracts, glaucoma, and even diabetes. While high doses or long-term therapy increase the risk of side effects, stopping therapy too abruptly carries its own dangers. I can’t stress this enough: NEVER stop taking any form of corticosteroids without discussing it with your physician first! While you are taking corticosteroids, your body’s adrenal gland, realizing that there are plenty of hormones around, stops making the usual amounts of cortisone that it usually does. If you stop taking those steroids suddenly, the adrenal gland won’t have time to immediately start up and make enough to keep your body functioning and you can suffer acute adrenal insufficiency, a serious and potentially fatal development. If the steroids aren’t weaned off slowly over a period of time, you run the risk of lupus flares or worsening symptoms. Additionally, if a person on long-term steroid therapy is going to undergo surgery or childbirth, or has any sort of trauma, they may need additional doses to compensate for the stress to the body.


Prednisone Tablets
Steroids come in varying forms, depending on the reason and strength that they are needed. Prednisone is an oral pill that comes in varying strengths from 1 mg to 50mg. You can take them once or twice a day, or every other day, depending on your symptoms and prescription. This is probably the most common form of steroid therapy for lupies because we can administer it ourselves at home, without the need for a nurse or doctor. Topical corticosteroids are commonly used on lupus rashes. It’s available as a cream, ointment or lotion, depending on the area needing treatment. While you can avoid some of the systemic side effects that come with other types of steroids, topical meds can carry other risks you should know about, like hypopigmentation (lightening of the skin), burning, irritation or dryness. Check with your physician to see if this type of medication might help you lower or eliminate the need for oral steroids. Depo-Medrol is an intramuscular injection, given in the gluteus or the deltoid. (Backside or arm) It lasts longer than an equivalent dose of oral medication, but has to be administered by a healthcare professional, which means either home health care or a doctor’s office visit. There is also an intravenous variation of Depo-Medrol. Also known as Solu-Medrol, it works immediately, and can last a week. Because of its fast onset of action, it’s the preferred method of administering steroids to people with adrenal insufficiency. However, because of the need for IV access, at least an outpatient hospital admission is usually necessary. (Unless you have a portacath or other permanent IV access, in which case it can be given by a nurse at home.)

It’s important for anyone undergoing corticosteroid therapy to discuss any questions or concerns with her physician both before and during the therapy. As tempting as it might be for the experienced lupie to "juggle" her own doses, it’s a very risky proposition, and it’s better to talk honestly with your docs in order to avoid a dangerous situation. Remember that you’re always better off knowing more about your available treatments, and that knowledge is power. Get the information that you need to be an informed patient advocate for yourself!


Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both. Thin weakened bones are more likely to fracture. Fractures of the vertebrae, wrists, or hips are usually the first indication. Symptoms such as lower back, neck, bone pain or tenderness may not occur until late in the disease. Loss of estrogen in older women is the most common cause associated with this condition. Corticosteroids ( Prednisone for example) can lead to a loss in bone density and may cause "secondary" osteoporosis in men and women of any age. Postmenopausal women taking corticosteroids are at a very great risk. Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, the body uses these minerals to produce bones. If calcium intake is not sufficient, or if the body does not absorb enough calcium from the diet, bone production and bone tissues may suffer. Steroids { corticosteroids) inhibit the body's absorption of calcium through the intestine then encourage calcium loss via the kidneys. A very serious condition can result from damaged bone cells deprived of blood supply by fatty clots from steroids. The lack of of oxygen leads to "dead bone" called avascular necrosis. Counteracting calcium depletion, slowing down or stopping bone loss, preventing bone fractures by minimizing the risk of falls, and controlling pain associated with the disease are the obvious goals for combating this health condition.

TESTS: Bone mineral density (BMD) or DEXA scans

Bone mineral density (BMD) testing -- as performed in dual-energy x-ray absorptiometry (DEXA) -- measures the demineralization of the bones. This has become the gold standard for evaluation for osteoporosis. The cost for DEXA scans run $200 - $300; but most insurance plans cover them. Anyone taking prednisone ( corticosteroids ) should be tested at least every one or two years; however, early on a patient should have a baseline bone-density test due to the rapid bone loss that takes place the first two years of steroid use.

OSTEOPOROSIS DRUGS: Actonel, Fosamax, Evista, et al

There are several different kinds of drugs used to treat osteoporosis. They vary in their side effects, benefits, and costs. Because of potential harm to a developing fetus, it is extremely important that women not only communicate to their doctors that they are pregnant but whether they have any plans to become pregnant. Lingering drugs may still affect pregnancy, so treatment and prevention may have to be through diet and exercise.


Convenient Packaging for Monthly Supply of Actonel
Bisphosphonates are a type of drug approved for both the prevention and treatment of osteoporosis. The two most well known marketed drugs -- alendronate (Fosamax) and risedronate (Actonel) -- prevent existing bone loss and reduce the risk of spinal and hip fractures.

While side effects are generally mild, potential side effects include stomach upset and irritation of the esophagus. Because bisphosphonates are difficult to absorb, these medicines should be taken on an empty stomach. The patient should not lie down or consume food or beverages (other than water) for at least 30 minutes after taking the medicine. The physician may also recommend taking calcium and Vitamin D supplements. If these drugs are not successful patients may have other options.

Raloxifene (Evista)
is another drug used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. (It does not appear to prevent other fractures, including those in the hip.) It may have protective effects against heart disease and breast cancer, though more studies are required. The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

Patients may be candidates for synthetic parathyroid hormone -- teriparatide (Forteo) -- a self administered daily injection that stimulates new bone and significantly increases bone mineral density. Side effects may include nausea, leg cramps or dizziness and should not be used before menopause or by those who have undergone radiation therapy. Another option -- calcitonin (Miacalcin) -- available as an injection or nasal spray. It slows bone loss and increases bone density of the spine in women that are post menopausal by more than 5 years. The injections may result in allergic reactions, and the nasal spray may cause bloody nose. Other possible side effects are similar to the bisphosphonates.

On the horizon a new drug, Prestara, a mild androgenic hormone, may be approved for the future and may even be safe for women who desire to get pregnant.


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