Living with Lupus

Prednisone, Corticosteroids, and Lupus

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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:

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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Comments (5)

5 thoughts on “Prednisone, Corticosteroids, and Lupus

  1. my daughter takes plaquinel for her mixed connective tissue disease/lupus and associated related issues. She was able to get only a 1 month supply of her meds and told by the pharmacist that it may not be available 30 days from now. What are these people who need and have been on this medication for years supposed to do to make sure they can get their medications

    1. I too take Plaquenil for Lupus (SLE) and RA. I’ve received quite a bit of information from different places stating they are trying to prioritize the medication goes without delays for patients like us. One idea I have, which is what I did, is to ask the doctor for a 90 day supply ( 180 if given 2x daily) and get it refilled at any pharmacy.

      ^This article above mentioned: “- if your pharmacy can’t fill your prescription, you’re safe for at least several weeks or longer. If you can, get advance prescriptions now in case the drug does become hard to get later. Most patients can miss doses for a few weeks without developing a disease flare, so long as they can restart it again when the drug is available. “

  2. My pharmacist had to use a work around to fill my plaquenil for 30 days. My insurance only wanted to fill for 14 days due to the COVID. They cannot do a 90 day fill at this time, and the doctor has to provide a diagnosis code, and no refills are authorized. Concerning steroids, they are a last resort for me, but if my pleurisy gets bad with a flare, then I will take it with a taper dose. It usually does the trick.

  3. I do not see a comment regarding the prednisone side effect that affected me. I developed Avascular Necrosis in my hips due to prednisone use for my Lupus. I had to have both hips replaced after they disintegrated due to blood flow loss

  4. FYI, my health insurance company put a requirement on all of their members to have authorization form from their doctor completed before they would pay for plaquinil. I called them as I already had an authorization months earlier because I’m allergic to talc and have to take the name brand drug, generic stopped making it years ago. If your insurance all of the sudden is denying a refill or prescription, call the insurance company ASAP.

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