Steroids play a crucial role in treating of systemic lupus erythematosus (SLE) by decreasing inflammation and preventing damage from the disease. However, figuring out the right timing, duration, dosage, and type of steroids can feel like solving a puzzle. Steroids can help you feel better quickly, but high doses or long-term steroid therapy may cause damaging side effects.

Currently, there’s no consensus among doctors about how much or how often people with lupus can take steroids. In general, most lupus treatment guidelines recommend using the lowest possible dose for the shortest possible time to avoid the side effects of steroids.

The dose and frequency you take depend on the type and severity of your symptoms, your other medical conditions, and your overall health. Discuss the risks and benefits of taking steroids for lupus with your doctor.

What Are Steroids?

In relation to lupus treatment, “steroid” is short for “corticosteroids” or “glucocorticoids” — a group of chemicals related to cortisol, your body’s natural anti-inflammatory hormone. The steroids you take for lupus are laboratory-made synthetic steroids that can help reduce inflammation, relieve symptoms, and prevent flare-ups.

Steroids work by suppressing your immune system to reduce inflammation. This is helpful when treating lupus — an autoimmune disease that causes your immune system to attack healthy tissues around your body.

Steroids can be used topically (on the skin), orally (taken by mouth), intravenously (injected into a vein), or intramuscularly (injected into your muscle), depending on the prescribed use of the steroid.

Systemic Steroids

Systemic steroids are given orally, intravenously, or intramuscularly and are used to decrease disease activity quickly during a flare-up because they work throughout your body.

The most commonly used systemic steroids include:

• Prednisone (Deltasone)
• Prednisolone (Orapred)
• Methylprednisolone (Medrol, Solu-Medrol)
• Dexamethasone (Decadron)
• Triamcinolone (Kenalog)
• Hydrocortisone (Cortef, Solu-Cortef) — Cortef is the brand name for the oral formulation and Solu-Cortef is the brand name for the intravenous formulation.

Your steroid dose will depend on the severity of your symptoms. Prednisone is the most common oral steroid prescribed for lupus. A low dose is considered 7.5 milligrams (mg) or lower of prednisone daily. A medium dose is considered between 7.5 mg and 30 mg of prednisone daily. A high dose is more than 30 mg of prednisone per day. You may also be prescribed other types of oral steroids, such as a methylprednisolone dose pack or dexamethasone.

During a lupus flare, your doctor may give you an intramuscular injection with triamcinolone in the office instead of prescribing an oral steroid.

If you have a severe lupus flare, you may receive intravenous steroids in the hospital. This treatment may be necessary if the flare is life-threatening or if it may damage organs such as the kidneys, heart, lungs, or brain. During a life-threatening flare, you may receive a high dose (250 mg to 1,000 mg) of methylprednisolone intravenously for three to five days to help reduce inflammation and get the flare under control. This is commonly called pulse therapy or pulse steroids.

Topical Steroids

Topical steroids are applied to your skin in a lotion, cream, or ointment. They may be used to treat rashes caused by lupus by decreasing inflammation. Topical steroids often have fewer side effects than systemic steroids if your lupus symptoms are limited to skin problems.

Common topical steroids include:

• Hydrocortisone (Cortizone)
• Triamcinolone (Kenalog)
• Betamethasone (Diprolene)

Most people will use a topical steroid once or twice a day for up to two weeks. It is important to use this medication exactly as your doctor prescribes it.

Short-Term Side Effects of Steroids

Side effects that go away when you stop taking medication are considered short-term side effects. Many people experience side effects while they are taking steroids. Side effects tend to be more common with higher doses taken for a longer period of time.

Common side effects of steroids include:

• Increased appetite and weight gain
• Stomach pain
• Heartburn
• Insomnia (problems falling or staying asleep)
• Restlessness
• Increased sweating
• Mood changes
• Fluid retention and swelling
• Moon face (swelling around your face)
• Thinning of the skin
• Acne
• Dizziness
• Muscle weakness

Long-Term Side Effects of Steroids

The long-term side effects of steroids can continue after you have stopped taking them. Taking a higher dose of steroids or taking them for a long period of time can put you at an increased risk of certain health conditions, such as:

• Infections — Steroids can cause immunosuppression, or make your immune system not work as well, which can make it harder for you to fight off infections.
• Impaired wound healing — It may take longer for wounds to heal when you take steroids because your immune system is suppressed.
• Cardiovascular disease (heart disease) — Long-term use of steroids can cause hypertension (high blood pressure), high cholesterol, and weight gain, which may increase your risk factors for a heart attack or stroke.
• Weak bones — Steroids can increase your risk of developing bone structure changes, which can cause osteoporosis (decreased bone strength) and lead to avascular necrosis (a lack of blood flow to the bone). This, in turn, can making it easier to break a bone.
• Eye problems — Steroids can increase your risk of cataracts (a condition that causes the lens of your eye to become cloudy) and glaucoma (a condition when excess fluid in your eye can cause damage to your optic nerve).
• Diabetes — Steroids can increase your blood sugar, which may lead to type 2 diabetes in some cases.
• Hormone changes — Steroids can affect how your body produces the hormone cortisol. Stopping steroid treatment suddenly can result in a life-threatening condition called adrenal insufficiency (adrenal glands do not make enough of certain hormones).

Not only can steroids increase your risk of health problems, but the damage caused by lupus may also increase your risk of heart disease, bone problems, and eye problems. Talk to your doctor about the benefits and potential risks of taking steroids.

What Do Lupus Treatment Guidelines Say About Steroids?

Health experts develop treatment guidelines to help health care professionals make the best possible recommendations based on scientific evidence. There are several different lupus treatment guidelines written by rheumatology associations in different countries, such as:

• The American College of Rheumatology
• The European Alliance for Associations for Rheumatology (EULAR)
• The British Society for Rheumatology
• The Latin American Group for the Study of Lupus

While these guidelines agree that steroids should be taken at the lowest dose for the shortest possible time, they don’t agree on the definition of low-dose steroids nor how fast you should decrease the dose after the flare is under control.

The most recent lupus guidelines were updated in 2019 by EULAR. They recommend a daily dose of 7.5 mg of prednisone or less to avoid steroid side effects. They also recommend stopping steroids safely when possible. Even though the risk of side effects is decreased with prednisone doses of less than 7.5 mg, studies show that even low doses can cause damage.

Reducing Steroid Use for Lupus Treatment

Both lupus and steroids can cause similar damage to organs like your kidneys. Differentiating between damage caused by lupus and that caused by steroids can be difficult. To reduce the dose of steroids you take, your doctor may prescribe you medication that you need to take regularly to prevent lupus flares.

Lupus treatment guidelines recommend antimalarials such as hydroxychloroquine (Plaquenil) for everyone with lupus. Hydroxychloroquine works by slowing down the immune system to help control lupus symptoms.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) can help treat pain and inflammation in your joints caused by lupus.

Immunosuppressive drugs can also help to taper off steroids and prevent flares.

Examples of immunosuppressant drugs include:

• Azathioprine (Imuran)
• Mycophenolate mofetil (Cellcept)
• Methotrexate (Rheumatrex)
• Cyclosporine (Neoral)
• Leflunomide (Arava)

Biologic drugs are made from living cells and may slow or stop inflammation. These drugs can also help prevent flares in people who haven’t been able to decrease their doses of prednisone below 7.5 mg of prednisone daily. Biologics work by targeting specific parts of the immune system to help reduce inflammation.

Examples of biologic drugs include:

• Belimumab (Benlysta)
• Rituximab (Rituxan)
• Anifrolumab-fnia (Saphnelo)

Although steroids can effectively reduce inflammation caused by lupus, you’ll need to carefully consider their possible side effects. Your doctor will provide guidance tailored to your specific needs, helping you make an informed decision. Always consult your doctor to discuss the potential risks and benefits associated with steroid use for lupus, as you should never start or stop taking steroids without first talking to your doctor.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 222,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

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