|
If you have any suggestions for future subjects you'd like to see
covered in Butterfly News, please email me - [email protected].
I've decided to write about steroids in this issue,
as they are one of the most common drugs used in the treatment of
lupus.
*********************************************
STEROIDS
Corticosteroids are synthetic drugs that closely resemble
cortisol, a hormone that your adrenal glands produce naturally.
They are commonly referred to "steroids." Corticosteroids give extra
strength & power to the body in times of need. Corticosteroids are
the strongest known anti-inflammatory drugs.
The most corticosteroid used to treat lupus is prednisone.
Others are prednisolone (which is chemically changed for easy passage
through the liver), hydrocortisone (weaker in strength than prednisone),
methylprednisolone (stronger than prednisone), & dexamethasone (which
is extremely potent & only used in unusual circumstances).
Steroids are used to treat lupus patients who do not
improve or are not expected to respond to NSAIDs or antimalarials.
Patients with organ threatening disease are usually put on steroids,
sometimes along with immunosuppresents (cyclosporin, etc). Steroids
can be taken orally, used topically (for skin rashes), injected
into the joints for arthritis, or given as an intravenous (IV) or
intramuscular injection.
Steroids work by decreasing inflammation and reducing
the activity of the immune system. Inflammation is a process by
which the body's white blood cells and chemicals protect the body
against infection and foreign substances such as bacteria and viruses.
In certain diseases, such as lupus, however, the body's defense
system (immune system) doesn't function properly. This may cause
inflammation to work against the body's own tissues and cause damage.
Inflammation is characterized by redness, warmth, swelling and pain.
Steroids reduce the production of inflammatory chemicals in order
to minimize tissue damage. Steroids also reduce the activity of
the immune system by affecting the function of white blood cells.
The dosage of steroids used varies from patient to
patient. Involvement of the heart, lungs, kidneys, liver or blood
is managed with high dose steroids - between 40 to 80 milligrams
a day. Severe flare-ups of non-organ threatening disease are treated
with moderate doses - 20 to 40 milligrams a day. Chronic, mild,
non-organ-threatening disease responds to daily doses of 2 to 20
milligrams a day.
Patients taking steroids must be very careful not
to stop taking the drug suddenly. The function of the adrenal gland
- a gland essential for life because it produces key hormones that
regulate salt & water metabolism, & it is the source of adrenaline,
"the fight or flight" hormone - is inhibited by large doses of corticosteroids
& "turns off" when they are administered. The gland can recover,
but it needs time. Therefore, stopping the drug suddenly results
in no cortisone in the body. This can be life threatening. Most
patients get very ill if they mistakenly stop their steroid therapy
abruptly. When one reduces the prednisone dosage gradually, the
adrenal gland gradually returns to full function. Once full function
returns, the drug can be completely discontinued. Some individuals
who have not been on the drug for very long (usually less than one
month), or who have tapered off with sufficient care that their
adrenal gland is back to normal, can come off the drug completely.
If you want to stop taking steroids, always seek your doctor's advice
before stopping the drug.
Although steroids can be a life saving drug, they
can cause many unwanted side effects. Side effects of steroids include
weight gain, high blood pressure, thinning of the bones (osteoporosis),
increased risk of diabetes, increased risk of infection, change
in body shape (thin arms & legs, increase in size of the abdomen),
poor sleep, increase in abdominal stretch marks, thinning of the
skin, easy bruising, cataracts, steroid psychosis, depression, increase
in facial hair & acne, avascular necrosis. As with all drugs, every
patient is different, some will get few side effects, others will
get more. The side effects experienced also depend on the dosage
of the drug used, and the length of time it is taken for. Side effects
such as osteoporosis & diabetes usually only occur after many years
of taking the drug. Whereas other effects like acne and weight gain
can occur after a relatively short time. There is some debate over
what the minimum dosage of steroids must be taken before someone
develops an increased risk of osteoporosis. General opinion is that
people taking more than 7.5mg a day for a long period of time are
at an increased risk.
Fortunately there are measures you can take to reduce
the risk of side effects. Keep to a low-sodium, low-fat, & low-carbohydrate
diet & limit your calorie intake. Diuretics can sometimes be prescribed
to deal with bloating & fluid retention. You should increase your
intake of calcium & vitamin D, taking a supplement if necessary.
Foods high in calcium include milk and milk products, tofu, soups
made with cream, milk or cheese, broccoli, chard, all greens, okra,
kale, spinach, sauerkraut, cabbage, soy beans, rutabaga, salmon,
dry beans. Include foods rich in zinc. These foods include oysters,
meats, seafood, poultry and eggs. Keep active to minimise the risk
of osteoporosis & muscle wasting. If possible, stay away from relatives
& friends who have colds or other infections. There may be an increased
need for vitamins B6, C, and zinc, speak to your doctor for advise
on taking supplements. See http://www.uklupus.co.uk/diet.html for
more dietary advice.
Steroids should be taken with milk or food to reduce
the risk of an upset stomach. Alcohol should be avoided, as steroids
can irritate the stomach, and alcohol can compound this action.
Your doctor will advise you as to whether occasional moderate drinking
is ok.
Conclusion
Steroids can be life saving, and can help lupus where
other drugs have failed, yet they have many undesirable side effects.
However, I know people who have been taking steroids for decades,
and they are fine. Steroids have made a big difference to my life
since I started taking them last year. Before that I was very restricted
due to joint & muscle pain, and now I feel like my life is back
on track. I was very undecided as to whether I should take steroids
at first, but now I'm sure I made the right decision. Patients should
just be aware of the side effects of steroids, and try to maintain
as low a dose as possible. Also take measures such as those mentioned
above, in order to reduce the risk of unwanted side effects further
down the line. And remember to always seek your doctors help when
you want to reduce the dose, or stop altogether.
*******************************************************
NEW ON THE SITE THIS WEEK
A new page on relaxation -
http://www.uklupus.co.uk/relax.html
Lupus news has been updated -
http://www.uklupus.co.uk/lupusnews.html
*******************************************************
© 2001 Joanne Forshaw/The Lupus Site http://www.uklupus.co.uk
No part of this newsletter may be reprinted in any way, without
written permission of the author.
|
Message
Boards
