Does Lupus Medication Make You Gain Weight?

October 9, 2025 •

4 min read

According to MyLupusTeam, weight gain is the most highly reported side effect of steroids by people with lupus. While not all treatments cause it, the question 'Does lupus medication make you gain weight?' is a significant concern for many patients navigating their treatment journey.

Quick Summary

Certain lupus medications, especially corticosteroids like prednisone, can cause weight gain through increased appetite, fluid retention, and fat redistribution. Other treatments and the condition's symptoms can also contribute to weight changes.

Key Points

Corticosteroids are a primary cause: Medications like prednisone are the most common lupus treatments associated with weight gain, through increased appetite, fluid retention, and altered fat storage.
Not all medications cause it: Other common lupus drugs like hydroxychloroquine and many immunosuppressants are not typically linked to weight gain and may even cause weight loss.
Weight gain from steroids is manageable: Lifestyle strategies, including a low-sodium diet, moderate exercise, and stress management, can help minimize weight gain from corticosteroid use.
Fluid retention can be mistaken for fat gain: Some medications and lupus-related kidney issues can cause fluid retention (edema), which adds to the scale but differs from fat accumulation.
Lupus symptoms contribute indirectly: Fatigue and joint pain, common lupus symptoms, can reduce physical activity levels, contributing to overall weight gain.

The Link Between Lupus and Weight

Systemic Lupus Erythematosus (SLE) is an autoimmune disease that causes inflammation throughout the body. While lupus itself doesn't directly cause weight gain, the symptoms and medications used to treat it can certainly impact a person's weight. Symptoms like severe fatigue, joint pain, and arthritis can make it difficult to stay physically active, reducing calorie expenditure. However, the most significant driver of weight gain is often the medication required to manage the disease, especially during flares.

The Role of Corticosteroids (Prednisone)

Corticosteroids, such as prednisone, are powerful anti-inflammatory drugs frequently used to control severe lupus flares. They are also the most common cause of medication-related weight gain in lupus patients. The mechanism behind this side effect is multi-faceted.

Increased Appetite: Prednisone mimics the body's stress hormone, cortisol, which can stimulate the appetite center in the brain, leading to increased hunger and higher calorie intake.
Fluid Retention: Corticosteroids cause the body to hold onto sodium and water, which results in bloating and swelling, particularly in the face, hands, ankles, and feet. This is often referred to as 'water weight.'
Fat Redistribution: Long-term or high-dose steroid use can cause body fat to redistribute and accumulate in certain areas, leading to a 'moon face' and a 'buffalo hump' (a fat pad on the upper back).
Altered Metabolism: Prednisone can affect how the body processes sugar, potentially causing insulin resistance and making it easier to store calories as fat.

Medications That Are Less Likely to Cause Weight Gain

Several other lupus medications are not typically associated with weight gain. Understanding their effects can provide clarity for patients concerned about this side effect.

Hydroxychloroquine (Plaquenil): This antimalarial medication is a cornerstone of lupus treatment. It does not directly cause weight gain, and some patients report weight loss as a potential side effect, possibly due to digestive issues like nausea. Fatigue and depression are potential side effects that could indirectly influence weight.
Mycophenolate Mofetil (CellCept): As a steroid-sparing immunosuppressant, mycophenolate can help patients reduce their prednisone dosage, which may lead to weight loss. While it doesn't cause weight gain itself, fluid retention (edema) is a possible side effect, and gastrointestinal issues like nausea can lead to weight loss.
Azathioprine (Imuran): Another immunosuppressant, azathioprine, is not known to cause weight gain directly. Like mycophenolate, it is often used to help reduce steroid dependence and can have side effects like nausea that may lead to weight loss.

Comparison of Lupus Medications and Weight Impact


Medication Category	Examples	Typical Effect on Weight	Associated Mechanism(s)
Corticosteroids	Prednisone, Methylprednisolone	Significant Weight Gain	Increased appetite, fluid retention, fat redistribution, altered metabolism
Antimalarials	Hydroxychloroquine	Minimal to No Weight Gain	Not a direct cause; possible weight loss from side effects like nausea
Immunosuppressants	Mycophenolate Mofetil, Azathioprine	Minimal to No Direct Weight Gain	Steroid-sparing effect can help reduce weight. Potential for weight loss due to GI side effects. Edema is possible with mycophenolate
NSAIDs	Ibuprofen, Naproxen	Fluid Retention	Can cause sodium and water retention, leading to bloating and temporary weight gain
Biologics	Belimumab (Benlysta)	Variable, Not Typically Associated	Less likely to cause weight gain. Can help reduce steroid use over time.

Strategies for Managing Medication-Related Weight Gain

For those experiencing weight gain from lupus medication, particularly corticosteroids, a multi-faceted approach can help manage the side effects. It is crucial to always consult with a healthcare provider before making any significant changes to your diet or exercise routine.

Dietary Adjustments:

Limit Sodium Intake: To combat fluid retention caused by steroids, reduce your salt intake to around 2,000 mg per day.
Choose Nutrient-Dense Foods: Focus on fruits, vegetables, lean proteins, and whole grains to feel full without excessive calories. This is especially important when dealing with increased appetite from prednisone.
Manage Blood Sugar: Prednisone can elevate blood sugar, so avoid simple carbohydrates and sugary foods. Instead, opt for complex carbohydrates like brown rice and legumes.
Increase Potassium: Counteract fluid retention by including potassium-rich foods such as bananas, melons, spinach, and yogurt in your diet.

Physical Activity:

Low-Impact Exercise: Choose joint-friendly activities like walking, swimming, yoga, or gentle stretching to stay active without putting excess strain on joints and muscles.
Listen to Your Body: Lupus symptoms like fatigue can fluctuate, so it's important to know your limits. Incorporate regular movement on good days and allow for rest on days when symptoms are more severe.

Lifestyle Management:

Manage Stress and Sleep: Lack of sleep and high stress levels can increase cortisol, exacerbating the effects of prednisone. Practice stress-reducing techniques like meditation or deep breathing.
Collaborate with Your Doctor: Discuss your weight concerns with your rheumatologist. They may be able to adjust your medication dosage, explore steroid-sparing alternatives, or refer you to a dietitian or physical therapist for personalized guidance.

Conclusion

For many people with lupus, the medication regimen is a critical tool for managing inflammation and preventing organ damage. While some of these treatments, most notably corticosteroids like prednisone, can lead to unwanted weight gain, others do not have this effect. Understanding the specific mechanisms behind medication-related weight changes, from increased appetite and fluid retention to fat redistribution, is the first step toward effective management. By working closely with your healthcare team and implementing targeted dietary, exercise, and lifestyle adjustments, it is possible to mitigate these side effects while continuing to effectively treat your lupus. For more information on managing lupus symptoms, visit the Johns Hopkins Lupus Center.

Frequently Asked Questions

While some weight gain may be unavoidable with higher doses of prednisone, you can minimize it by adopting a low-sodium diet, engaging in regular low-impact exercise, and managing stress and sleep. Always consult your doctor before starting a new diet or exercise plan.

No, hydroxychloroquine is not known to cause weight gain directly. In clinical studies, weight loss was reported more often than weight gain, possibly due to side effects like nausea or loss of appetite.

'Moon face' is the term for the facial swelling caused by fat redistribution from corticosteroid use. It typically begins to resolve after the steroid dosage is reduced or discontinued, though it may take time for the fat stores to normalize.

Lupus does not directly cause weight gain. However, its symptoms, such as fatigue and joint pain, can make it difficult to stay active, which can lead to weight gain. Co-occurring conditions like lupus nephritis (kidney inflammation) can also cause fluid retention.

Mycophenolate (CellCept) does not cause weight gain in itself. It is often used to help reduce steroid dosage, which can lead to weight loss. However, it can cause peripheral edema (swelling) that can make it seem like you have gained weight.

Weight gained from fluid retention typically subsides quickly after reducing or stopping the medication. However, fat gained during treatment may take longer to lose and requires a healthy diet and regular exercise, similar to any other weight loss effort.

Medications like corticosteroids and NSAIDs can cause the body to retain sodium and water. Following a low-sodium diet helps to reduce this fluid retention, minimizing bloating and swelling that contribute to weight gain.