Corticosteroids are hormones secreted by the cortex of the adrenal gland. SLE 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 SLE. 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 if they have been taken for more than 4 weeks. Administration of corticosteroids causes the body's own production of adrenal hormones to slow down or stop, and adrenal insufficiency will 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.

Types of Corticosteroids

Prednisone (Orasone®, Meticorten®, Deltasone®, Cortan®, Sterapred®), a synthetic corticosteroid, is most often used to treat lupus. Others include hydrocortisone (Cortef®, Hydrocortone®), methylprednisolone (Medrol®), and dexamethasone (Decadron®). Corticosteroids are available as a topical cream or ointment for skin rashes, as tablets, and in injectable form for intramuscular or intravenous administration.

Mechanism of Action and Use

The frequently prescribed 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. These drugs are usually administered orally. During periods of serious illness or prior to surgery, they may be administered intravenously; once the patient has been stabilized (or patient is able to have oral fluids after surgery), oral administration should be resumed.

Side/Adverse Effects

Central Nervous System: depression, mood swings, and psychosis

Cardiovascular: congestive heart failure (CHF) and hypertension*

Endocrine: Cushing's syndrome, menstrual irregularities, and hyperglycemia

Gastrointestinal: GI irritation, peptic ulcer, and weight gain

Dermatologic: thin skin, petechiae, ecchymoses, facial erythema, poor wound healing, hirsutism,* urticaria, and acne

Musculoskeletal: muscle weakness, loss of muscle mass, and osteoporosis*

Ophthalmologic: increased intraocular pressure, glaucoma, exophthalmos, and cataracts*

Other: immunosuppression and increased susceptibility to infection

Pregnancy and Lactation

Corticosteroids cross the placenta, but can be used cautiously during pregnancy. They also appear in breast milk; patients taking large doses should not breastfeed.

Considerations for Health Professionals Assessment: History: hypersensitivity to corticosteroids, tuberculosis, infection, diabetes, glaucoma, seizure disorders, peptic ulcer, CHF, hypertension, and liver or kidney disease Laboratory data: electrolytes, serum glucose, white blood cell (WBC) count, cortisol level Physical: all body systems to determine baseline data and alterations in function, weekly weight gain of >5 pounds, GI upset, decreased urinary output, increased edema, infection, temperature, pulse irregularities, increased blood pressure, and mental status changes (e.g., aggression or depression) Evaluation: therapeutic response, including decreased inflammation and adverse effects Administration: with food or milk (to decrease GI symptoms) Teaching Points: See Patient Information Sheet on Corticosteroids.

Source: National Institutes of Health, U.S.Dept of Health and Human Services