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:
- high doses of corticosteroids are required
- corticosteroids are used for an extended period.
- 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:
- 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.
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
- 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.
- 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.