Prednisone, Corticosteroids, and Lupus
Prednisone is a corticosteroid that can reduce the symptoms of lupus. However, it comes with several severe side effects, making it a challenging medication to manage.
Lupus Warriors are likely familiar with prednisone, or its brand name Rayos. It is the most commonly prescribed corticosteroid to help people with lupus, particularly during periods of high disease activity or flares.
Corticosteroids work quickly to limit the activity of the immune system and decrease inflammation. This causes a dramatic reductions in symptoms including:
swelling
tender joints and muscles
warm-to-the-touch skin
skin lesions and rashes
Many lupus treatment plans include it alongside other immune system suppressants and anti-inflammatory medication such as cyclophosphamide or Myophenolate mofetil. Because of this, vulnerability to infection and disease is a major concern for prednisone treatment.
Routes and dose
It is usually given by mouth in a pill at a high dose, often between 5mg-60mg per day. Though, it can be higher. Corticosteroids are toxic, and can damage organs over time. You lupus treatment team will prescribe as low a dose as possible. People often taper their doses (slowly decrease them) over time as symptoms improve. You can read more about steroid tapering here.
When looking to use the medication to mitigate cutaneous lupus symptoms, you can also use a cream or gel form.
Liquid forms may also be injected into muscles (cortisone shots) or delivered via an infusion (pulse steroids).
Side Effects of Prednisone
Prednisone can be a very harsh medication for lupus. All if its forms (immediate-release tablet, delayed-release tablet, and liquid solution) have potential health risks and side effects. These include the usual side effects of corticosteroids:
Mood swings, agitation, confusion and other brain-related symptoms of lupus
Nausea and vomiting
Insomnia
Vulnerability to infection
Weight Gain (particularly in the face, known as moon face)
Skin symptoms
acne
delicate skin
However, it can also cause:
Severe allergic reactions
Eye and vision problems
High blood sugar levels
High blood pressure issues
Prednisone also interacts with many other medications, including diabetes medications and blood thinners. When taken with NSAIDs (non-steroidal anti-inflammatory medications) it can increase the risk of gastrointestinal issues.
It can also make people with lupus more vulnerable to vaccine complications. While people with lupus should get vaccines for themselves and their close family members, they should avoid live vaccines while on prednisone.
Low-dose options
Researchers have investigated whether a lower dose of prednisone would treat lupus effectively while minimizing side effects.
In one 2017 study, patients were given cyclophosphamide and prednisone at 30mg a day or less. Withdrawal from prednisone and other corticosteroids can be severe and it usually takes time to reduce the dose. However, patients tapered down to 2.5-3 mg of prednisone over 12-14 weeks (3 months). They also had an additional intravenous pulse of 125mg of methyl prednisone every two weeks, so the dose they were measuring was just the daily oral dose.
Even with just the reduced daily dose, the researchers still measured an improvement. Disease activity was measured using the SLEDAI index, which includes evaluations of both visible and organ-related lupus activity. Researchers found improvements in renal (kidney) health and other lupus symptoms with fewer side effects and complications, including lower rates of organ damage. This research implies that doses of 30mg or less a day may be a safer option than the current standard.
However, as with any medication, speak with your lupus treatment team about dosing for you.
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