This post is prompted by a report on the BBC about excessive over prescribing of Prednisone by GP's in the UK
http://www.whale.to/drugs/corticosteroids1.html
The best doctors explain to their patients why they are prescribing a medicine , how it might help them, what undesirable side effects to look out for, when and how best take the medicine and arrange tests to check for hidden side effects. . Doses will be adjusted according to the patient's individual needs and response.
Unfortunately we often see lupus sufferers here on the forum who have been treated with Prednisone or similar oral steroids for many years as sole therapy and are now suffering serious irreversible side effects.
We need to be informed about our medicines to make sure that our treatment is in line with the most up to date practices and that we are getting the best treatment available, although of course it is up to our doctors to decide in partnership with us on treatment options and choices.
Many of us have no choice but to be treated by doctors who are not lupus specialists, have little or no experience of treating lupus patients and who are not up to date with the latest therapies.
Dr Wallace writes
Steroids are the most effective and most misunderstood treatment for lupus. They are also the most used and abused therapeutic interventions for the disease.
Simply stated, if organ threatening disease is present and steroids are not prescribed, the patient usually loses function in that organ.
(The Lupus Book p212)
He also describes steroids as a blessing and a curse. " Without them many lupus patients would die, but with them, serious complications can arise.........
Not everybody develops all of these complications and many individuals who are steroid dependant develop none of them "
(pps 216-217)
These days every effort is made to keep steroid use to the lowest dose for the shortest time needed. Monotherapy - the use of a single drug - is unusual these days : most often a cocktail of drugs is prescribed to maximise the benefits of each and minimise the side effects.
The anti malarials, NSAID's and the steroid sparing drugs Imuran and Methotrexate help to reduce the need for steroids in disease control.
Some cases never need steroids. Some will need low maintenance doses for long periods
Measures can be taken to minimise the side effects of steroids : Dr Wallace often prescribes antacids,H2 blockers, eg Zantac or proton pump inhibitors eg Prilosec along with steroids.
A low sodium low fat and low carbohydrate diet with limited calorie intake is advisable.
Sometimes diuretics are used to minimise bloating and fluid retention.
Sedatives may be useful at night and patients are urged to be active to minimise muscle atrophy and osteoporosis
Dr Wallace says that steroid dependent patients should take at least 1 gram of calcium a day to protect their bones. Bone loss is a serious concern of long term steroid use for men as well as women regardless of age . There are a number of osteoporosis and bone building medicines available these days. Bone density should be checked as often as required.
Here is a small selection of useful links and information to help you evaluate the treatment you are getting
Please note: this is not medical advice, just freely available information. Always consult your physician. Physicians differ in their prescribing and treatment practices.
________________________________
Side effects
http://www.rxlist.com/cgi/generic/pred_ad.htm
>>>Musculoskeletal: Muscle weakness, steriod myopathy, loss of muscle mass, osteoporosis, tendon rupture, particularly of the Achilles tendon, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, and pathologic fracture of long bones
http://www.whale.to/drugs/corticosteroids1.html
The best doctors explain to their patients why they are prescribing a medicine , how it might help them, what undesirable side effects to look out for, when and how best take the medicine and arrange tests to check for hidden side effects. . Doses will be adjusted according to the patient's individual needs and response.
Unfortunately we often see lupus sufferers here on the forum who have been treated with Prednisone or similar oral steroids for many years as sole therapy and are now suffering serious irreversible side effects.
We need to be informed about our medicines to make sure that our treatment is in line with the most up to date practices and that we are getting the best treatment available, although of course it is up to our doctors to decide in partnership with us on treatment options and choices.
Many of us have no choice but to be treated by doctors who are not lupus specialists, have little or no experience of treating lupus patients and who are not up to date with the latest therapies.
Dr Wallace writes
Steroids are the most effective and most misunderstood treatment for lupus. They are also the most used and abused therapeutic interventions for the disease.
Simply stated, if organ threatening disease is present and steroids are not prescribed, the patient usually loses function in that organ.
(The Lupus Book p212)
He also describes steroids as a blessing and a curse. " Without them many lupus patients would die, but with them, serious complications can arise.........
Not everybody develops all of these complications and many individuals who are steroid dependant develop none of them "
(pps 216-217)
These days every effort is made to keep steroid use to the lowest dose for the shortest time needed. Monotherapy - the use of a single drug - is unusual these days : most often a cocktail of drugs is prescribed to maximise the benefits of each and minimise the side effects.
The anti malarials, NSAID's and the steroid sparing drugs Imuran and Methotrexate help to reduce the need for steroids in disease control.
Some cases never need steroids. Some will need low maintenance doses for long periods
Measures can be taken to minimise the side effects of steroids : Dr Wallace often prescribes antacids,H2 blockers, eg Zantac or proton pump inhibitors eg Prilosec along with steroids.
A low sodium low fat and low carbohydrate diet with limited calorie intake is advisable.
Sometimes diuretics are used to minimise bloating and fluid retention.
Sedatives may be useful at night and patients are urged to be active to minimise muscle atrophy and osteoporosis
Dr Wallace says that steroid dependent patients should take at least 1 gram of calcium a day to protect their bones. Bone loss is a serious concern of long term steroid use for men as well as women regardless of age . There are a number of osteoporosis and bone building medicines available these days. Bone density should be checked as often as required.
Here is a small selection of useful links and information to help you evaluate the treatment you are getting
Please note: this is not medical advice, just freely available information. Always consult your physician. Physicians differ in their prescribing and treatment practices.
________________________________
Side effects
http://www.rxlist.com/cgi/generic/pred_ad.htm
>>>Musculoskeletal: Muscle weakness, steriod myopathy, loss of muscle mass, osteoporosis, tendon rupture, particularly of the Achilles tendon, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, and pathologic fracture of long bones
