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Corticosteroids for Lupus: Balancing Risks, Benefits

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Corticosteroids are a primary treatment option for a wide range of inflammatory and autoimmune conditions. A popular book on lupus provides details on their risks and benefits.

The benefits can be measured in terms of increased life expectancy. In 1955, the survival rate at five years for lupus patients was only 50 percent. By 1995, the survival rate at 20 years had already reached 80 percent. In addition, many women stay healthy enough to keep their jobs and independence for decades after diagnosis with lupus and other autoimmune diseases.

But the risks of corticosteroids are serious enough to warrant very careful monitoring and dosage adjustments, as well as the addition of steroid-sparing drugs. Dr. Sasha Bernatsky describes both short term and long term side effects. The short term effects, which can generally be reversed by decreasing the dose, are:

1. Weight gain and facial changes. These steroids can greatly increase appetite, and cause a redistribution of fat cells to the face.

2. Mood changes. Different people react differently. Some feel energetic and euphoric, while others feel depressed or irritable. Sleep disturbance is also common.

3. Acne. This may start or get worse with corticosteroids.

4. Facial hair. Some patients notice coarser or more plentiful facial hair.

5. Upset stomach. Taking the medication with food may help.

6. High blood sugar. Diabetics may require a change in their therapy, and patients at risk for diabetes need careful monitoring.

7. High blood pressure. Careful monitoring is important.

8. Increased risk of infections. Since inflammation is our first line of defense against infections of all types, all anti-inflammatory medications increase the risk. Corticosteroids are powerful enough to be of great concern.

9. Swelling or water retention. These medications change the body's transport of salts. You may notice swelling, especially of the ankles.

Long term side effects are more serious but less common. If you take corticosteroids for many months or years, these can be issues:

1. Osteoporosis

2. Glaucoma and cataracts

3. Avascular necrosis, also called osteonecrosis

4. Heart disease and stroke

5. Adrenal insufficiency

Source one recommends a team including rheumatologist, ophthalmologist, nephrologist, dietician, pharmacist, clinic nurse and psychologist to treat lupus. Be sure to monitor your own symptoms and keep your health care providers informed of what's happening whenever you take medication that has a strong affect on the immune system.

1. Sasha Bernatsky, MD, and Jean-Luc Senecal, MD, editors, “Lupus: Everything You Need to Know”, Firefly Books, 2005.

2. Rosalind Joffe and Joan Friedlander, “Women, Work, and Autoimmune Disease: Keep Working, Girlfriend!”, DemosHealth, 2008.

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.



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