Lupus And Prednisone
If you have lupus, you likely will be introduced at some point in the course of your disease to prednisone, or one of its pharmacological cousins. Prednisone is a glucocorticoid and is a synthetic form of cortisol, a hormone that occurs naturally in the body.
In 1950 two physicians from the Mayo Clinic received the Nobel Prize for synthesizing cortisone, a prednisone precursor. This drug improved the lives of people who have lupus and people who are suffering from many other conditions.
Today, glucocorticoids remain the cornerstone of lupus treatment, though a host of other drugs have been found effective in controlling the disease (though no drug can cure lupus). While steroids can often control symptoms of lupus, they are notorious for the side effects that may accompany their use. Researchers are still examining the unintended but often unavoidable consequences of therapeutic steroid use.
The natural hormone that prednisone mimics, cortisol, is present in the bloodstream throughout the day; it is a powerful regulating agent. In an emergency, the adrenal cortex is prompted to release more of this hormone so that the body can marshal its resources to meet the crisis. Systemic effects of increased cortisol include suppression of the immune response, increased heart rate and elevated blood pressure.
It is precisely because prednisone acts like cortisol in suppressing the immune system that it is so useful in treating autoimmune diseases. Unfortunately, prednisone is not a targeted medication. It cannot zero in on the immune system and leave the rest of the body unaffected. Some of the potential side effects of prednisone are: cataracts; diabetes; pancreatitis; acne; bone loss (osteoporosis); bone necrosis; hair loss; hair growth; adrenal insufficiency; high blood pressure; weight gain (especially trunk); psychosis; insomnia; blood clots; immune deficiency; glaucoma; ulcer; long-term migraines; mouth sores; joint pain; facial swelling; gastric bleeding; atherosclerosis.
Because of the diffuse and profound effect that steroid therapy has on the body, discontinuation is accomplished gradually, through a “weaning” process. The adrenal cortex has to be, in effect, trained to start reproducing cortisol. Failure to gradually wean off steroids can be very dangerous.
Recent research suggests that doses of prednisone below 90 mgs a month are not likely to result in organ damage; however, this finding is not certain. Some of the conditions for which prednisone has been found to be effective are: Crohn’s disease, lupus, rheumatoid arthritis, Non-Hodgkin’s lymphoma, Hodgkin’s lymphoma and sarcoidosis. While a variety of autoimmune diseases respond well to prednisone, it has to be used with great caution in the treatment of scleroderma because of the risk of acute renal crisis.
One of the ways prednisone is effective in tamping down the immune response is by suppressing cell proliferation. A challenging aspect of prednisone therapy is that it can precipitate some of the very disorders it is used to treat. For example, while mania may be a manifestation of lupus and may successfully be addressed by administration of prednisone, there is also a form of mania which can be caused by taking prednisone. Also, prednisone may be prescribed to treat cluster headaches or migraines, and yet long-term use of prednisone has been implicated in causing chronic migraine.
It has been noted that women who had been on steroid therapy during their first trimester have a greater chance of bearing offspring with cleft palate.
Often, steroids are used in conjunction with other immunosuppressive agents; sometimes this is done to increase the effectiveness of therapy. Alternately, dual therapy is often introduced so that a patient may be “spared” steroid exposure.
As with every medicine I describe, prednisone therapy can have profound and irreversible effects. However, for the treatment of systemic lupus, or other debilitating diseases, prednisone can be a life-saver. Understanding its benefits and risks is essential for a patient who has to cooperate in treatment decisions.