Corticosteroids are hormones secreted by the cortex of the adrenal gland. The term "steroids" is often misunderstood. Confusion results when corticosteroids are mistaken for anabolic steroids.
Lupus patients with symptoms that do not improve or who are not expected to respond to NSAIDs or antimalarials may be given a corticosteroid. Although corticosteroids have potentially serious side effects, they are highly effective in reducing inflammation, relieving muscle and joint pain and fatigue, and suppressing the immune system. They are also useful in controlling major organ involvement associated with lupus.
These drugs are given in much higher doses than the body produces and act as potent therapeutic agents. The decision to use corticosteroids is highly individualized and is dependent upon the patient’s condition.
Once the symptoms of lupus have responded to treatment, the dose is usually tapered until the lowest possible dose that controls disease activity is achieved. Patients must be monitored carefully during this time for flares or recurrence of joint and muscle pain, fever, and fatigue that can result when the dosage is lowered. Some patients may require corticosteroids only during active stages of the disease; those with severe disease or more serious organ involvement may need long-term treatment.
Treatment with corticosteroids must not be stopped suddenly. Administration of corticosteroids causes the body’s own production of adrenal hormones to slow down or stop, and adrenal insufficiency, or even adrenal crisis (a potentially life-threatening state) may result if the drug is stopped suddenly. Tapering the dose allows the body’s adrenal glands to recover and resume production of the natural hormones. The longer a patient has been on corticosteroids, the more difficult it is to lower the dose or discontinue use of the drug.
Corticosteroids used to treat lupus include:
Prednisone, which is a synthetic steriod, is the corticosteroid most often used to treat lupus.
Corticosteroids are available as:
- topical creams or ointments (for skin rashes)
- oral tablets
- liquid solutions
- steriod shots (intramuscular or intravenous injections)
Corticosteroids are highly effective in reducing inflammation and suppressing the immune response. These drugs may be used to control exacerbation of symptoms and are used to control severe forms of the disease. Corticosteroids are usually administered orally. During periods of serious illness, they may be administered intravenously; once the patient has been stabilized, oral administration should be resumed.
Immunosuppressives / DMARDs (Disease-Modifying Anti-Rheumatic Drugs)
Immunosuppressives and other disease-modifying anti-rheumatic drugs (DMARDs) are used in treating serious, systemic cases of lupus in which major organs such as the kidneys are affected or in which there is severe muscle inflammation or intractable arthritis.
Because of their steroid-sparing effect, immunosuppressives may also be used to reduce or sometimes eliminate the need for corticosteroids, thereby sparing the patient from undesirable side effects of corticosteroid therapy.
Immunosuppressives and DMARDs can have serious side effects. Patients need to understand, however, that side effects are dose dependent and are generally reversible by reducing the dose or stopping the medication.
There are many serious risks associated with the use of immunosuppressives and DMARDs, These include:
- increased susceptibility to infection
- bone marrow suppression
- development of malignancies
A variety of immunosuppressive drugs and other disease-modifying anti-rheumatic drugs are available to treat lupus. All of these apply to a group of drugs essentially used as a second line of defense against lupus and other forms of arthritis. Although they have different mechanisms of action, each type functions to decrease or prevent an immune response.
Immunosuppressives and DMARDs used to treat lupus now include:
- Azathioprine (Imuran)
- Cyclophosphamide (Cytoxan)
- Mycophenolate (CellCept)
- Methotrexate (Rheumatrex)
- Cyclosporine (Sundimmune, Neoral)
In choosing any particular medication or drug therapy to combat lupus, you and your physician must carefully weigh the benefits and the risks of the treatment plan.
Source: NIAMS, Lupus: A Patient Care Guide for Nurses and Other Health Professionals