Positive Options for Living with Lupus by Philippa Pigache Page B
Authors: Philippa Pigache
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energy and disposes of waste), the development of sexual characteristics, immune function, the balance of fluids in the body, and its tolerance of stress. There are many steroids with different functions; the sex hormones (testosterone, estrogen, and progesterone), adrenal cortical hormones, bile acids, sterols, anabolic agents, and oral contraceptives are all steroids. Corticosteroids are not the same as anabolic steroids, the ones taken by weight lifters to build muscle. The role of corticosteroids is protective: They maintain the fluid balance in the body and help it cope with stress; along the way they reduce inflammation.
Doses and Delivery Regimen of Steroids in
Lupus Treatment
In the treatment of lupus, the role of steroids is anti-inflammatory.
Nowadays the pros and cons of corticosteroids are better understood, and their use, delivery, and dosage have been refined. They have probably advanced the treatment of lupus more than any other drug, and almost every person with lupus will take them at some time or other, on a short-or a long-term basis. Doctors prescribing them follow strict guidelines.
Getting the dose right—not too much, not too little—is central to the administration of steroids. Inflammation is the healthy response to infection, so if it is suppressed (by drugs) the patient becomes vulnerable to infection; hence it is essential that the dose is kept as low as is effective. In Graham Hughes’ experience, a seriously ill patient may briefly require as much as 60 mg daily, reducing to 30–40 mg after one or two weeks. Milder cases might receive 15–20 mg daily for the first few weeks, reducing to a maintenance dose of 5–10 mg a day. Reducing the daily dose of steroids must always be done gradually and with the cooperation of the patient. It is possible to reduce high doses on a steeper gradient, but a reduction of a dose that is lower than 20 mg must always be extremely gradual—as little as 1 mg a month—in Graham Hughes’ experience.
POL text Q6 good.qxp 8/12/2006 7:39 PM Page 70
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Po s i t i v e O pt i o n s fo r L i v i n g w i t h L u p u s (This fine-tuning can be hampered by the difficulty of finding 1 mg tablets, requiring the patient’s cooperation in neatly cutting up pills with a razor blade.)
A number of steroid drug regimens may be employed. They are most commonly taken by mouth; the most widely used drug is prednisolone (or prednisone). ACTH (adrenocorticotrophic hormone) is an injectable form of steroid that is administered twice weekly, and methylprednisolone is given via a drip into a vein. This can obviously only be done in the hospital, but for seriously ill people it can be a useful way of delivering large doses of steroids with surprisingly few side effects. (When steroids are taken by mouth they are available in a coated form to reduce the usual unpleasant gastric side effects.) At the other end of the dose scale is the practice of prescribing steroids to be taken on alternating days, to allow the natural source of steroids—the body’s own adrenal glands—to re-boot. One of the principle side effects of steroid treatment is that the body, recognizing that large amounts of the stuff are washing around, cuts back on home production. This is why coming off steroids must be done gradually—to let the adrenal glands limber up and get back into production.
Taking low-dose steroids, for example 7.5 mg a day, even for a limited period, causes other side effects. Two are quite common: sleep disturbance and increased appetite. As has been explained, steroids control metabolism, which in turn determines when energy and attention levels go up and when they come down, and, accord-ingly, the cycles of attention and sleepiness that constitute your body clock. Some people who take steroids find their body clocks totally reversed; they’re wide awake at three in the morning and sleepy at three in the afternoon, as though they had been working the night shift or had just
Doses and Delivery Regimen of Steroids in
Lupus Treatment
In the treatment of lupus, the role of steroids is anti-inflammatory.
Nowadays the pros and cons of corticosteroids are better understood, and their use, delivery, and dosage have been refined. They have probably advanced the treatment of lupus more than any other drug, and almost every person with lupus will take them at some time or other, on a short-or a long-term basis. Doctors prescribing them follow strict guidelines.
Getting the dose right—not too much, not too little—is central to the administration of steroids. Inflammation is the healthy response to infection, so if it is suppressed (by drugs) the patient becomes vulnerable to infection; hence it is essential that the dose is kept as low as is effective. In Graham Hughes’ experience, a seriously ill patient may briefly require as much as 60 mg daily, reducing to 30–40 mg after one or two weeks. Milder cases might receive 15–20 mg daily for the first few weeks, reducing to a maintenance dose of 5–10 mg a day. Reducing the daily dose of steroids must always be done gradually and with the cooperation of the patient. It is possible to reduce high doses on a steeper gradient, but a reduction of a dose that is lower than 20 mg must always be extremely gradual—as little as 1 mg a month—in Graham Hughes’ experience.
POL text Q6 good.qxp 8/12/2006 7:39 PM Page 70
7 0
Po s i t i v e O pt i o n s fo r L i v i n g w i t h L u p u s (This fine-tuning can be hampered by the difficulty of finding 1 mg tablets, requiring the patient’s cooperation in neatly cutting up pills with a razor blade.)
A number of steroid drug regimens may be employed. They are most commonly taken by mouth; the most widely used drug is prednisolone (or prednisone). ACTH (adrenocorticotrophic hormone) is an injectable form of steroid that is administered twice weekly, and methylprednisolone is given via a drip into a vein. This can obviously only be done in the hospital, but for seriously ill people it can be a useful way of delivering large doses of steroids with surprisingly few side effects. (When steroids are taken by mouth they are available in a coated form to reduce the usual unpleasant gastric side effects.) At the other end of the dose scale is the practice of prescribing steroids to be taken on alternating days, to allow the natural source of steroids—the body’s own adrenal glands—to re-boot. One of the principle side effects of steroid treatment is that the body, recognizing that large amounts of the stuff are washing around, cuts back on home production. This is why coming off steroids must be done gradually—to let the adrenal glands limber up and get back into production.
Taking low-dose steroids, for example 7.5 mg a day, even for a limited period, causes other side effects. Two are quite common: sleep disturbance and increased appetite. As has been explained, steroids control metabolism, which in turn determines when energy and attention levels go up and when they come down, and, accord-ingly, the cycles of attention and sleepiness that constitute your body clock. Some people who take steroids find their body clocks totally reversed; they’re wide awake at three in the morning and sleepy at three in the afternoon, as though they had been working the night shift or had just
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