Medicines

How Long Will I Take Corticosteroids?

Once the symptoms of lupus have responded to treatment, the dose of corticosteroids is gradually reduced (tapered). Meanwhile the individual is carefully watched worsening (relapse) of the disease.

• The longer a person has been on corticosteroids, the more difficult it generally becomes to lower the dose.
• It is very important that corticosteroids are taken exactly as prescribed.
• Treatment should never be stopped abruptly without consulting with a physician.

Corticosteroid Side Effects

There are many complications of corticosteroid treatment, and the risks of these complications are increased when:

1. high doses of corticosteroids are required
2. corticosteroids are used for an extended period.

Corticosteroids may:

• produce changes in physical appearance:
  • weight gain
  • puffy cheeks
  • thinning of the skin and hair
  • easy bruising.
• cause stomach discomfort such as dyspepsia or heartburn.
  • These may be minimized by giving the drug with meals or along with medications that prevent stomach damage.
• Cause marked changes in mood, including:
  • depression
  • mood swings.
• Cause diabetes.
• increase the risk of infections, muscle weakness, or cataracts.
• have an effect on the bones including:
  • joint damage of the hips, knees, or other joints (osteonecrosis or avascular necrosis).
• produce osteoporosis (thinning of bone) when given over long periods.
  • In most people, calcium or other medications to prevent osteoporosis are given along with the corticosteroids.

Anti-Malarial Drugs

Drugs used for the treatment of malaria are widely used in the management of lupus symptoms.

• The drug hydroxychloroquine (brand name: Plaquenil) is the most commonly used of the anti-malarial agents.

When Should My Doctor Prescribe Anti-Malarials?

• Anti-malarials are particularly effective in the treatment of:
  • lupus arthritis
  • skin rashes
  • mouth ulcers.
• Other possible benefits of anti-malarials include:
  • reducing the risk of blood clots
  • lowering cholesterol levels.
• Anti-malarials are considered to have a small risk of causing birth defects.
• Anti-malarials are generally not recommended for women who want to become pregnant.

Anti-malarial Side Effects

Low-Dose Therapy

• abdominal symptoms (stomach pain or dyspepsia)
• rashes or darkening of the skin
• muscle weakness
• shortly after starting treatment, there may be a temporary mild blurring of vision, which resolves on its own.

High-Dose Therapy

• In high doses (such as those used in the treatment of malaria), certain anti-malarial drugs may damage the retina of the eye, causing vision problems.
• With the low doses of anti-malarials used in the treatment of lupus, the risk of this complication is extremely low.
• However, as a precaution, people treated with anti-malarials generally have a thorough eye examination before the drug is started, and then every 6-12 months during therapy.
  • This screening is done so that any sign of damage to the retina can be detected early and, if needed, the drug can be stopped.