Steroid Side Effects and Sock Indentations: A Patient's Inquiry - Internal Medicine

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Hello Ann,
Thank you for your inquiry regarding the side effects of steroid use and the changes in your body, particularly in relation to your lupus treatment. It’s important to understand how corticosteroids can affect your body and the potential side effects associated with their long-term use.

Corticosteroids, such as prednisone, are commonly prescribed for autoimmune conditions like lupus to help reduce inflammation and suppress the immune system. However, they can also lead to a variety of side effects, especially when used at higher doses or for extended periods. One of the well-known side effects of corticosteroids is changes in body weight and fat distribution. This phenomenon, often referred to as "Cushingoid appearance," can manifest as increased fat in the abdomen, face (moon facies), and back of the neck (buffalo hump).
The timeline for these side effects can vary significantly from person to person. Generally, changes in weight and fat distribution can begin within a few weeks to months of starting corticosteroid therapy, especially if the dosage is high. In your case, since you have increased your dosage from three to five pills over the past three years, it is plausible that the changes in your body composition are related to your steroid use rather than solely due to dietary or lifestyle changes. However, it’s also essential to consider other factors, such as caloric intake, physical activity, and overall health, which can contribute to weight gain.

Regarding the sock indentations you mentioned, this can be a sign of mild edema (swelling due to fluid retention), which is not uncommon in individuals taking corticosteroids. The fact that the indentations disappear after a short period suggests that it may not be severe. However, given your history of high blood pressure and lupus, it’s wise to monitor this symptom closely. Edema can occur due to various reasons, including kidney function issues, heart problems, or simply from prolonged sitting or standing.
To determine whether your symptoms are related to water retention or other underlying issues, consider the following:
1. Monitor your weight: Keep track of any sudden increases in weight, which could indicate fluid retention.

2. Check for other symptoms: Look for signs such as shortness of breath, increased fatigue, or changes in urination patterns, which could suggest more serious issues.

3. Blood pressure management: Since you have high blood pressure, ensure that it is well-controlled, as hypertension can contribute to fluid retention.

4. Consult your healthcare provider: Given your medical history, it is crucial to discuss these changes with your doctor. They may recommend blood tests to assess kidney function, electrolytes, and other relevant parameters.

In summary, the changes in your body shape and weight could very well be related to your corticosteroid use, especially given the dosage and duration. The sock indentations may indicate mild edema, but it’s essential to evaluate this in the context of your overall health and any other symptoms you may be experiencing. Regular follow-ups with your healthcare provider are vital to manage your lupus effectively and to monitor for any potential side effects of your medications.

Take care, and I hope this information helps you understand your situation better. Please feel free to reach out with any further questions or concerns.