Steroid Tapering, Health Benefits, & Lupus

Changes in steroid dosing can be difficult to keep up with, but important for total health. Successful steroid tapering of prednisone has increased for Lupus Warriors since 2000, according to a study.

During a lupus flare, you want to feel better. But, the strategies that work to get symptoms under control are often very different than what is necessary for the day-to-day management of lupus.

A lupus treatment plan is often made up of doctor-prescribed medications like non-steroidal anti-inflammatory drugs (NSAIDs), antimalarials, immunosuppressants, and steroids. Of these, steroids can be particularly challenging to manage because they offer long-term risks, like organ damage, despite providing short-term relief from symptoms. We will explore steroids, the risks and challenges associated with the medications, and tips for tapering.

What Are Steroids?

The term “steroid” is used to describe medications that have a particular molecular configuration. This core structure is composed of 17 carbon atoms fused into four rings. There are many different types of steroids including:

• Corticosteroids
  • Glucocorticoids
• Sex steroids
  • Estrogen
  • Progesterone
  • Testosterone
• Secosteroids
  • Vitamin D
• Neurosteroids
  • Dehydroepiandrosterone (DHEA)

People with lupus often take corticosteroids. These medications help regulate the function of the immune system and decrease inflammation throughout the body. Common corticosteroids are:

• Cortisone
• Prednisone
• Prednisolone
• Hydrocortisone
• Methylprednisolone (Medrol)
• Dexamethesaone (Decadron)
• Triamcinolone IM

Corticosteroids can be taken in four different ways:

1. Orally
   • Tablets, capsules, syrups
2. Topically
   • Creams and ointments
3. Via Injection
4. Inhaled
   • Inhaler or intranasal spray

Common Steroid Side Effects

Steroids are known to cause side effects. Because of this, you should work with your lupus treatment team to adjust dosing to minimize the impact on your health. Often this means trying to take steroids for short periods of time only. Side effects can vary by the method of ingestion, but common side effects include:

• Weight gain
• Acne
• Infection
• Irritability
• Difficulty sleeping
• Elevated pressure in the eyes
• Fluid retention and/or swelling in the legs
• High blood pressure
• Problems with memory or mood

Additionally, long term use of steroids can lead to more serious medical conditions like osteoporosis, cataracts, glaucoma, or muscle weakness. To learn more about potential side effects, check out the Johns Hopkins Lupus Center.

What is Steroid Tapering?

Steroid tapering is the process of slowly decreasing the amount of steroid taken. For people with lupus, this process can take a few months. However, longer tapers may be necessary for prolonged steroid treatment (more than 1 year taking steroids).

According to a 1998 study published in American Family Physician, a stepped reduction is the recommended tapering schedule. Every 3 to 7 days, reduce the steroid dosage. Depending on the medication, the reduction amount and success threshold can vary. Be sure to develop a plan with your lupus treatment team.

The purpose of steroid tapering is to help your body adjust. Corticosteroids mimic the effects of hormones that your body naturally produces in your adrenal glands, like cortisol. However, when you are taking the medication, your body begins to decrease the natural production of hormones. Suddenly stopping a steroid can trigger withdrawal symptoms like fatigue, muscle aches, weakness, nausea, and/or loss of appetite.