All About Glucocorticoids and Lupus: Risks, Benefits, Alternatives

Lupus is a challenging condition and, for many reasons, is hard to detect until it becomes well rooted in the body. There are many subtle early warning signs of the disease which can be mistaken for other ailments. The pathology of Lupus is the body’s immune system mistakenly attacks itself, this classifies it as an autoimmune disease. Disease progression often leads to systemic inflammation and irreversible organ damage. Race, socioeconomic status, genetic predisposition, gender, and age are associated with its onset and severity. A Journal of Rheumatology study published in 2021 found a similar disease severity for lupus and other autoimmune diseases. Lupus places a disproportionate economic burden on patients as well as the overall healthcare system. This burden is being carefully considered in light of the innovative research being conducted to not only treat this condition but to eventually cure it. 


What are Glucocorticoids? 

For now, healthcare providers utilize clinical rheumatology guideline recommendations which suggest the use of several agents for the management of Lupus. Prolonged disease remission is the goal of therapy as there is no cure for Lupus at this time. While antimalarials such as Hydroxychloroquine are considered first line treatment, glucocorticoids are also commonly prescribed to reduce inflammation and prevent organ damage. Their mechanism of action suppresses the overactive immune system, which by definition is the culprit in all autoimmune diseases, including Lupus. 


Glucocorticoids for Lupus Treatment 

Glucocorticoids have proven to be successful in slowing disease progression and preventing relapses while taken at relatively low doses. The most commonly prescribed glucocorticoid for Lupus is prednisone, which is typically prescribed at ≤7.5 to 5 mg/day ranging from four weeks to 12 months. Higher doses of glucocorticoids haven’t proven to be more effective, but have increased side effect profiles. Prednisone may be taken orally in tablet or liquid form. Other glucocorticoids may be used if prednisone is not well tolerated or an alternative form such as topical or intramuscular injections are required or preferred. 


Glucocorticoid Benefits and Risks 

The benefits of using glucocorticoids such as prednisone include their well understood anti-inflammatory mechanism of action, high effectiveness, cost utilization, and easy access. All of these factors influence one’s ability to take medication as prescribed and necessary. If there is one thing I’ve learned as a healthcare provider, it’s that with any chronic condition, medication adherence is key to treatment success. Glucocorticoids can falter in this area. Although prednisone has proven to be effective in prolonging relapse time, its side effect profile can be problematic for long term use and adherence. Prolonged usage of prednisone can lead to a variety of side effects including cardiovascular problems such as high blood pressure and fluid retention, hyperglycemia and diabetes, weak bones and osteoporosis, psychiatric concerns such as depression, and increased risk of infections. In addition to these, a particularly unique side effect of steroid use is irregular fat distribution which can lead to cushingoid appearance and can cause changes in a person’s physical features. 


Alternatives to Glucocorticoids

With the many risks involved in prolonged use of glucocorticoids for lupus, various clinical research studies are being conducted to seek out alternatives. At this time antimalarials, NSAIDS, and immunosuppressive medications may be used in conjunction with lifestyle modifications. These combinations may help prolong remission times and disease progression in patients with mild to moderate Lupus. While removing low dose glucocorticoids has shown shortened remission periods and increases in flare severity, new research shows that complete discontinuation of glucocorticoids is achievable in lupus remission; durable remission (5 years or more) and hydroxychloroquine (HCQ) therapy may significantly reduce the risk of flare.   


The Future of Lupus Treatment 

Much investment is being put forth towards innovative research to develop therapies with minimal side effects and high effectiveness. It is vital to patient health and the healthcare systems to keep patients with lupus in remission and new research is key. The participation of those diagnosed with lupus in research studies can help accelerate medical progress. Check out Sanguine studies for lupus research participation opportunities. 


By Nadia Bhatti

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