If you notice your feet, ankles, or legs swelling while on prednisone, you might wonder if it’s a side effect of the medication or associated with lupus. Prednisone is the most common steroid used to treat lupus, also called systemic lupus erythematosus (SLE).

Corticosteroids like prednisone help slow and block overactive immune system responses in the body, which is important when treating autoimmune diseases such as lupus. Without curbing the inflammatory response, healthy tissues and internal organs can be damaged and may cause swelling, stiffness, pain and tenderness, and warmth in different parts of the body.

Although prednisone works to help address lupus symptoms like swelling, it can also cause the body to hold on to too much fluid, which can then result in swelling. There may be other lupus-related reasons for swelling in the feet too. Keep reading to learn more about prednisone and swelling in the feet, other causes of swelling in people with lupus, and ways to manage it.

Prednisone and Swelling

Fluid retention is a notorious side effect of prednisone. This means your body holds on to more water than usual. Fluid buildup can make certain areas of the body look swollen or puffy, especially in the face, midsection, and legs. Fluid retention from prednisone can also lead to weight gain.

One study that looked at the side effects of methylprednisolone (a stronger version of prednisone) found that approximately 13 percent of study participants experienced swelling in the face or extremities (arms and legs). More research is needed to find out how common swelling in the feet is among people with lupus who take prednisone — specifically, high doses of prednisone.

Many MyLupusTeam members have experienced swelling while taking prednisone. As one MyLupusTeam member put it, “Prednisone causes you to swell anywhere and everywhere.”

Swelling in the feet and ankles seems to be a common experience. “Ankle swelling happens to me with my prednisone,” one member noted. “I’ve just been diagnosed with lupus (SLE), and my doctor put me on prednisone for two weeks. My feet, ankles, and hands are really puffy and swollen so much that they hurt,” another shared.

Prednisone can also cause a redistribution of fat in the body, which often leads to a swollen appearance in the face (“moon face” or Cushing’s syndrome) or abdomen. The arms and legs usually look thin in comparison.

Side effects like swelling usually go away if the dose is lowered or when you stop taking prednisone, as the body returns to normal levels of fluid retention.

Lupus and Swelling

While fluid retention and swelling are common side effects of prednisone, swelling may be a symptom of lupus itself. “I swell a lot too, even when I am not on prednisone,” a MyLupusTeam member wrote. Lupus can cause swelling in the feet, in the hands, or around your eyes.

Inflammation from lupus can cause tissue damage, which can show up as swelling, pain, and stiffness in the body. Swelling along with joint pain may be a sign of a lupus flare. While corticosteroids like prednisone work to reduce these inflammatory responses, if you’re experiencing flare symptoms while taking prednisone, it’s best to talk with your doctor to see if a different dose or medication is needed to help your symptoms.

In addition, swelling and pain may be a withdrawal symptom or a sign that you need to taper prednisone more slowly. Not tapering prednisone properly may lead to a worsening of symptoms that you’re taking prednisone to treat. Swelling that occurs when you’re going off prednisone may be a sign of lupus symptoms returning.

One member shared that swelling in their joints happens when their doses are reduced: “I’ve been on prednisone and Medrol since 1995. When trying to reduce, I experience increased pain, fatigue, and swollen joints, so I’ve just decided to just stop trying to reduce and go through the pain.”

Talk with your health care provider about any plans to try tapering your prednisone dose, and be sure to follow instructions on tapering to avoid unwanted withdrawal or flare symptoms.

Lupus Nephritis and Swelling

Swelling in the legs, ankles, and feet can also be symptoms of lupus nephritis, a type of kidney disease. Lupus nephritis is characterized by kidney damage and poor kidney function, which can lead to fluid retention and swelling. About 50 percent of people with lupus have lupus nephritis.

It can be difficult and concerning to wonder if kidney problems are at the root of your swelling. One MyLupusTeam member wrote, “I don’t know if the swelling is from the prednisone or from my kidneys. I’m supposed to be on a low-sodium diet as well. I have to take Lasix, but there’s swelling in my ankles, stomach, and face.”

Although swollen ankles don’t always mean kidney problems, because lupus nephritis is common and can get worse over time, it’s important to be aware of it. If you’re concerned that swollen ankles are a sign of lupus nephritis, talk to your doctor so that they can diagnose the underlying cause and talk to you about the risks and other symptoms of lupus nephritis to watch out for.

How To Manage Swelling in Your Feet

You may be able to manage swelling in your feet at home. In addition, your doctor may prescribe you medications to help reduce swelling and discomfort.

Elevate Your Feet

Swelling in the feet may improve by putting your feet up so that excess fluid can drain. This temporary relief does not change the fact that prednisone causes fluid retention, but it may briefly ease the swelling.

“When my ankles do swell, I actually elevate my feet on pillows and just lie down until the swelling goes down,” one MyLupusTeam member shared. Another wrote, “I prop my legs up higher than my chest, and sometimes I’ll put cold, wet towels over my feet.”

Diet and Exercise

Prednisone can cause the body to hold on to too much salt, which then causes it to keep extra water, causing fluid retention and swelling. A low-salt diet and exercise may help reduce fluid retention.

Consider reducing the amount of salt you put in meals, and try looking for low-sodium foods when grocery shopping or eating out. While low-sodium diets are generally a good idea, be sure to talk with a health care professional about changes to your diet, especially if it results in any changes to your lupus symptoms.

In addition, exercise may help manage swelling from prednisone by increasing blood flow and how much you sweat, both of which can help with fluid retention. One MyLupusTeam member wrote, “For me, prednisone causes a slow gradual swelling that should decrease just as slowly. … Drink as much as you can and move, move, move!”

Diuretics To Help With Fluid Retention

Because fluid retention is a well-known side effect of prednisone and other steroids, your doctor might also prescribe a diuretic. A diuretic helps your body get rid of more salt and water, which should help reduce swelling.

Being on a diuretic may make you urinate more as your body tries to get rid of the excess fluid. “Usually, I take a diuretic called amiloride. … I’m on it once a day, but if my ankle starts swelling, they have me on it twice a day, and that takes care of it,” a MyLupusTeam member shared.

Over-the-Counter Medications

Be sure to talk to your doctor before trying any nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, to reduce swelling. Taking NSAIDs and prednisone together may cause an increased risk of stomach ulcers.

When To Talk to Your Doctor

Even though some swelling is common while on prednisone, it’s still important to tell your doctor about it, especially if the swelling gets worse. Let your doctor know right away if you’re experiencing swelling in your feet, ankles, or lower legs. In addition, call your doctor right away if you have swelling in any of the following body parts:

• Arms
• Hands
• Throat
• Face
• Tongue
• Lips
• Eyes

Higher doses of steroids and long-term use increase the risk of serious side effects. Because of this, they’re often given at the lowest dose possible and for the shortest amount of time. If side effects occur, your doctor may consider switching to a lower dose or different medication, if possible.

Describing a loved one’s experience taking prednisone, one MyLupusTeam member shared, “She has been tapered down on the prednisone. Since the adjustment in medications, there has been less swelling in the ankles but puffiness in the face.”

When in doubt, let your doctor know about any new symptoms so they can determine whether these could be a side effect of medication or another issue connected to lupus. Furthermore, your doctor can provide guidance and discuss available treatment options with you.

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.

Have you had swelling in your feet after starting or stopping prednisone? How have you managed it? Share your experience in the comments below, or start a conversation by posting on your Activities page.