Systemic lupus erythematous (SLE) is a chronic autoimmune disease where the immune system mistakenly recognizes parts of the body as foreign and begins an immune response. When a cell undergoes apoptosis, the nuclear material can become exposed. Normally the material is cleared efficiently and the immune system recognizes it as its own which prevents a reaction. In SLE, many abnormalities allow for the body to recognize this nuclear material as foreign, creating antibodies against one’s own material. A common example is production of anti-dsDNA antibodies. This can become widespread where multiple organ systems can be affected.
Learning about this disease is very different from seeing a person you love have it. Avoiding sun exposure, maintaining a healthy diet, adequate sleep, managing stress are common recommendations by rheumatologists followed by an extensive list of medications that can reduce flares. Aside from the extensive list of symptoms, one’s life completely changes. Your ability to perform daily activities are compromised, especially during a flare yet people are expected to remain optimistic. Seeing a loved one be diagnosed at 20 and living by their side, really makes you realize how mentally strong they are. Although medication regimen differs from person to person, steroids like prednisone and methylprednisolone are commonly prescribed. These steroids are considered synthetic glucocorticoids that mimic the natural hormones to reduce inflammation and suppress the overactive immune system. They are able to bind to glucocorticoid receptors and reduce the release of pro-inflammatory cytokines. There have been side effects to prolonged use of glucocorticoids including reduced immune activity due to immunosuppression, increase in blood glucose which can cause insulin resistance, cardiovascular risks and cortisol production suppression due to the negative feedback response that our body follows. Although untreated lupus inflammation can damage tissues and organs, too much glucocorticoid treatment is also damaging. A “tapering down” steroid treatment is recommended for lupus management yet studies show that immediate withdrawing of glucocorticoids use after a one year use can cause a four-fold increase in lupus flare months after withdrawing.
After learning the side effects, patients can be prompted with many ethical questions about using these medications. What do you think are the ethical standards for medication use? Should physicians be prompted to explain the long term side effects more thoroughly of using these options? What do you think is the connection between GC use in lupus and the chronic stress leading to elevated GC? Let me know what you think!
Sources:
Martin-Iglesias, D., Paredes-Ruiz, D., & Ruiz-Irastorza, G. (2024). Use of Glucocorticoids in SLE: A Clinical Approach. Mediterranean journal of rheumatology, 35(Suppl 2), 342–353. https://doi.org/10.31138/mjr.230124.uos
Lupus Foundation of America. (2025, November 3). Medications used to treat lupus. https://www.lupus.org/resources/medications-used-to-treat-lupus
Shiozawa, S. (2025). Pathogenesis of Autoimmunity/Systemic Lupus Erythematosus (SLE). Cells, 14(14), 1080. https://doi.org/10.3390/cells14141080
Zero To Finals. (2020). Systemic lupus erythematosus (SLE) – Signs and symptoms, pathophysiology, investigations, treatment [Video]. Systemic lupus erythematosus (SLE) – Signs and symptoms, pathophysiology, investigations, treatmen. YouTube Zero To Finals [https://youtu.be/g9dSVkqzs7k?si=ia-ZrqVBzg_kIlh2
I think all of these are very important questions when it comes to Lupus treatment. Just because we can treat flare-ups doesn't mean it is a long-term treatment. Also, think about what other body systems glucocorticoids can affect, which include steroid-induced glaucoma. Finding medications that can treat the underlying cause rather than the symptoms should be considered not only as a potential research avenue but from an ethical standpoint as well, of non-maleficence in standard patient care.
ReplyDeleteHi Emily! It's really interesting how you talk about glucocorticoids as a treatment for SLE. I did not know that long-term use of glucocorticoids can reduce immune activity due to immunosuppression, increase glucose levels, and suppress cortisol production. Your study shows that some treatment that takes longer could make the disease worse instead of treating it, and I think it's important for people to understand. Not only this treatment, but sometimes people keep taking medicine with the hope of getting better, and it's important to understand that sometimes it makes things worse. For instance, sometimes taking antibiotics for a long time makes bacteria resistant to antibiotics and makes it difficult to treat bacterial infections. After reading your post, I wonder how healthcare professionals would know that glucocorticoid treatment is doing more harm than good for a patient with SLE? Also, since glucocorticoids reduce immune activity, do you think that long-term treatment could make patients more susceptible to infection?
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