Living well with lupus

Lupus Canada
FACT SHEET

C
An Introduction to Corticosteroids and Anti-Malarial Drugs
sorticosteroids, such as prednisone, methylpred- Other steroids can be applied topically as a cream or
nisolone and prednisolone, are often prescribed injected into the skin for discoid rashes. Some may be
to treat systemic lupus erythematosus (SLE or injected directly into joints to reduce inflammation.
lupus). (Note: corticosteroids are not to be confused with Occasionally, very large doses of steroids may be
anabolic steroids, which are popular with weightlifters for administered for a short period of time intravenously
building muscle.) (pulse) to achieve results quickly. Your
doctor may also prescribe steroids in
Cortisone is a steroid manufactured
When prescribing steroids, combination with other medications,

your doctor will choose a

naturally by the body’s adrenal such as anti-malarials, non-steroidal
glands. It has a distinct anti-inflammatory drugs (NSAIDs)

dose that minimizes the

anti-inflammatory effect. Synthetic and cytotoxic drugs.
steroids reduce inflammation
caused by lupus and suppress
risk of side effects while Short-term side effects

keeping lupus symptoms

immune system activity, but they The lower the dosage of steroids given over a
also cause a variety of side effects, shorter period of time, the less likely a patient

under control
some of which can be quite serious. will experience severe side effects. Changes in
Side effects occur more frequently appearance and mood are more apparent with
when high doses of steroids are high doses. Remember that you are unlikely to
taken over a long period of time. experience all of these side effects. Taking med-
When prescribing steroids, your doctor will choose a dose ication in the morning may help reduce side effects.
that minimizes the risk of side effects while keeping lupus
symptoms under control. Many short-term side effects are Short-term conditions could include the following:
reversible and/or treatable. There are also many preventa- •Weight gain caused by an increase of appetite. To manage
tive measures to reduce the risks of several long-term side weight gain, eat a healthful diet and stay active. Talk to
effects. your doctor before beginning any exercise program.
•Redistribution of fat cells, causing the appearance of extra
Types of steroids weight in the face, abdomen and upper back, and reduced
Prednisone is the most frequently prescribed weight in the arms and legs
steroid used in the treatment of lupus. Taken orally, •Puffy, round, moon-shaped face, often called “chipmunk
the synthetic corticosteroid preparation comes in cheeks”
1, 5, 10 and 20 milligram (mg) tablets. It may be taken •Water retention (edema). To reduce water retention, avoid
as often as four times each day or as infrequently as salty foods.
once every other day. Ten mg per day or less is •Acne
generally considered a low dose; 11 to 40 mg daily •Facial hair and body hair growth
is a moderate dose; and 41 to 100 mg daily is •Mood swings including irritability, agitation, euphoria or
a high dose. depression
•Insomnia

Working together to conquer lupus

•Easy bruising due to fragile, thinning skin When tapering your medication, it’s a good idea to ask
•High blood pressure (hypertension). your doctor to write down your tapering schedule. Use a
•High blood sugar (hyperglycemia); calendar or tape the directions to your refrigerator or
symptoms include blurred vision, thirst and cupboard door. Refer to it when you refill your pill
more frequent urination organizer each week. It is also wise to wear a MedicAlert
•Increased risk of infection bracelet or carry a card that provides information about
•Stomach ulcers and upset stomach. To protect the the medications you are taking. Since it is common for
stomach, take steroids with food. your steroid dosages to change, especially if you are ta-
•Hyperactivity pering your medication, keep the card up to date. You
will need to know this information for all of your
Long-term side effects different doctor’s appointments.
•Osteoporosis (thinning of the bones). Calcium and

Adjusting your
vitamin D supplements and other medications can help
prevent osteoporosis.

dosage of
•Glaucoma and cataracts

corticosteroids
•Muscle weakness
•Adrenal insufficiency

without your
•Osteonecrosis (or avascular necrosis),
damage to the bones caused by impaired

doctor’s supervision
blood flow. It most often occurs in the hips,

is risky
but can also affect the shoulders, knees and
other joints, sometimes requiring joint re
placement.
•Premature arteriosclerosis. In combination
with other risk factors including lupus Adjusting your dosage of corticosteroids without your
itself, long-term use of corticosteroids can doctor’s supervision is risky. Abruptly stopping the med-
lead to a narrowing of the blood vessels by ication is also very dangerous and could be fatal. Since
fat (cholesterol) deposits, which can cause corticosteroids used to treat SLE, such as prednisone, are
heart attacks and strokes. very similar to cortisone produced naturally by the body’s
adrenal glands, the body may stop producing the hor-
Managing your medication mones that drive the natural production of cortisone
If you have a question about your steroids, ask your while on a synthetic steroid. Usually, as the steroid dose is
doctor. It is important that you understand what steroids slowly tapered, the body resumes producing normal lev-
do, how much you should take and when. els of these hormones. However, after prolonged use of
the drug, your glands may have trouble returning to nor-
If you’ve forgotten to take your steroids, take it as soon mal. If you have persistent fatigue, lightheadedness or
as you remember. Don’t wait until the next day, and do nausea as your dose is reduced, alert your doctor.
not double the medication you take to make up for a
missed dose. Use a pill organizer to keep track of your Conclusion
pills, to remind you when to take the medications, and to Researchers are hard at work developing new therapies
help you recognize when you’ve missed a dose. that will, it is hoped, have fewer side effects than steroids.
 Living well with lupus

For the time being, prednisone and reported immediately to a physician:

other steroids are the first-line therapy •Blurred vision WHAT IS THE
for lupus because they are extremely •Extreme nervousness, irritability,
effective when taken properly. dizziness, or difficulty focusing
AMSLE R GRID ?
•Confusion and seizures
•Muscle aches and weakness
The Amsler Grid is a
Introduction to anti-malarial drugs
Anti-malarial drugs, such as hydroxy-
screening test to assess

chloroquine (Plaquenil), chloroquine

the macula, which is the

It is extremely important
centre of the retina. The
(Aralen) and quinacrine (Atabrine), have Grid is a block of evenly

that you have a thorough

been used in the treatment of systemic spaced vertical and
lupus erythematosus since the 1950s.

eye examination when

horizontal lines (usually
Originally used to protect against the black lines on white paper)
infectious disease malaria, anti-malarial
starting treatment with this
with a small dot in the
drugs also provide relief from some skin middle. The patient is

drug and every 6 – 12

conditions and joint pain. Anti-malarials
asked to focus on the
are effective in controlling lupus arthri-
small dot, but also to

months after that

tis, skin rashes, mouth ulcers, inflamma-
watch for any grid lines in
tion of the heart lining (pericarditis) and
the peripheral vision that

lung lining (pleuritis), and other symp-

are not straight or areas of

toms, such as fatigue and fever. It is not

the grid that are missing in

effective in treating more severe symp-

the line of vision. Notify
Long-term side effects your doctor if any changes
toms of lupus, such as organ involve- A major potential side effect of in the Amsler Grid home
ment. Anti-malarials are low-toxicity anti-malarial use is damage screening test are noticed.
drugs, but they are also slow-acting. It to the retina of the eye. The low doses
can take weeks or months to see results. currently used in the treatment of lupus
are rarely associated with this condition;
Short-term side effects permanent loss of vision has only
These side effects are usually temporary. occurred in a very small number of
If they persist, contact your doctor. patients. Still, it is extremely important
This is a condensed list from

•Upset stomach that you have a thorough eye examina-

the Lupus Medications Fact

•Abdominal bloating and cramps tion when starting treatment with this
Sheet. See this Fact Sheet
for more details on medica-
•Loss of appetite drug and every six to 12 months after tions to treat lupus and tips

•Nausea, vomiting, loose stools and that, and that your eye doctor be made
to manage your treatments.

diarrhea aware that you are taking anti-malarials.

•Muscle aches and weakness He or she should provide a piece of
•Some people note changes in their hair paper with an Amsler grid, which you
and skin, have more headaches, but this should use once a week. Tape the grid to
is not common your refrigerator and add it to a chore
(for example, do laundry and
These uncommon, but potentially check eyes).
important side effects should be

Working together to conquer lupus

 QUICK TIPS

Anti-malarial drugs
• When taking any medication, make sure you follow

provide relief from some

the directions

skin conditions and

• Try to take your medication at the same time(s)
each day

joint pain…and other • Ask which side effects are considered serious enough

symptoms such as
to require immediate medical attention

fatigue and fever

• Do not adjust dosages without the input of a physician

• Use a days-of-the-week pill container to organize

your medication

• Always inform every doctor you see about your lupus

and all of the medications you’re taking
Managing your medication
Your dosage of anti-malarials is based on your ideal • Keep your drugs away from children and pets, and
body weight. Never take more than what has been store them in a cool, dry place
prescribed by your doctor.
• Do not take any new medications, over-the-counter,
Most rheumatologists now believe it is safe to use
naturopathic or otherwise, until you’ve consulted your

hydroxychloroquine during pregnancy. However, you

rheumatologist.

should discuss all potential medical risks, including

medications, with your doctor when planning a
pregnancy. Do not smoke, as this lessens the
effectiveness of the drug.
FOR M ORE IN FORM ATION
• Lupus Canada: www.lupuscanada.org. This site
includes electronic versions of the Living Well with
Conclusion
As with any medication, anti-malarials must be taken
Lupus fact sheets.

properly in order to be effective. Speak with your doctor

or pharmacist if you are unsure how or when to take
• Lupus: The Disease with a Thousand Faces,
your medication.
edited by Dr. Sasha Bernatsky and Dr. Jean-Luc Senécal, Key
Porter Books (2004) ISBN 1-55263-603-8. Contact Lupus
Canada to order this book.

Disclaimer
Systemic lupus erythematosus is an autoimmune disease that affects thousands of Canadians,
mostly women in their childbearing years. Symptoms vary greatly from person to person and
treatment is highly individualized. Patients are urged to contact their physician or healthcare
professional with any questions or concerns they might have.

Lupus Canada
590 Alden Road, Suite 211
Markham, Ontario L3R 8N2
(905) 513-0004
lupuscanada@bellnet.ca
www.lupuscanada.org

Publication Date: June 2007