Steroids are crucial in treating systemic lupus erythematosus (SLE) by decreasing inflammation and preventing damage caused by 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. That might make you wonder, “How many times can I take steroids?”

There’s no consensus among doctors about how often people with lupus can take steroids over the course of a year. 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 dosage and frequency of steroids you take will depend on the type and severity of your symptoms, your other medical conditions, and your overall health. It’s important to 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 versions 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 a muscle), depending on the prescribed use.

Systemic Steroids

Systemic steroids are given orally, intravenously, or intramuscularly. They’re used to reduce flare-up symptoms quickly by working throughout the body. Examples of the most commonly used systemic steroids include:

• Dexamethasone
• Hydrocortisone (sold as Cortef for the oral drug and Solu-Cortef for the IV drug)
• Methylprednisolone (Medrol and Solu-Medrol)
• Prednisolone (Orapred)
• Prednisone (Deltasone)
• Triamcinolone (Kenalog)

Your steroid dose will depend on the severity of your symptoms. Prednisone is the most common oral steroid prescribed for lupus. Typically, a low dose of prednisone is considered 7.5 milligrams or less daily. A medium dose is considered between 7.5 and 30 milligrams daily. A high dose is more than 30 milligrams 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 or increasing the dose of an oral steroid.

If you have a severe lupus flare, you may receive IV steroids in a hospital setting. This treatment may be necessary if the flare is life-threatening or may damage organs such as the kidneys, heart, lungs, or brain. During a life-threatening flare, you may receive a high dose (250 to 1,000 milligrams) 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 to treat lupus-related rashes by decreasing inflammation. If your lupus symptoms are limited to skin problems, topical steroids often have fewer side effects than systemic steroids.

Common topical steroids include:

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

Most people use a topical steroid once or twice a day for three to seven days. It’s important to use this medication exactly as your doctor prescribes it.

Short-Term Side Effects of Steroids

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

Common side effects of steroids include:

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

Long-Term Side Effects of Steroids

Long-term side effects of steroids are those that continue after you’ve stopped using the medication. Taking a higher dose of steroids or taking them for a long period can raise your 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.
• Delayed wound healing —Your immune system is suppressed, so it may take longer for wounds to heal when you take steroids.
• 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 bone structure changes, leading to osteoporosis (weakened bones) and lead to avascular necrosis (lack of blood flow to the bone), which can make fractures more likely.
• 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 (when adrenal glands don’t make enough of certain hormones).

Steroids can increase your risk of health problems, and lupus-related damage may further raise your risk of heart disease, bone issues, and eye conditions. Talk to your doctor about the benefits and potential risks of taking steroids.

What Do Lupus Treatment Guidelines Say About Steroids?

Treatment guidelines are developed to help healthcare professionals make the best possible recommendations based on scientific evidence. Lupus treatment guidelines are written by several rheumatology associations in different countries, such as:

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

Although these guidelines agree that steroids should be taken at the lowest dose for the shortest possible time, they differ on the definition of low-dose steroids and how quickly the dosage should be reduced after a flare is under control.

EULAR updated the most recent lupus guidelines in 2023. They recommend a daily dose of 5 milligrams of prednisone or less to avoid steroid side effects. They also recommend stopping steroids safely when possible. Even though the risk of side effects falls with prednisone doses of less than 5 milligrams, studies show that even low doses can cause damage.

Reducing Steroid Use in Lupus Treatment

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

Lupus treatment guidelines recommend antimalarials, such as hydroxychloroquine (Plaquenil), for all individuals 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 joint pain and inflammation caused by lupus.

Immunosuppressive drugs can also help with tapering off steroids and preventing flares. Examples of immunosuppressant drugs include:

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

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 5 milligrams daily. Biologics work by targeting specific parts of the immune system to help reduce inflammation. Examples of biologic drugs include:

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

Although steroids can effectively reduce lupus-related inflammation, it’s important to carefully consider the 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 of steroid use for lupus, and never start or stop taking steroids without medical guidance.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 234,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

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