Impact of Missing a Week of Plaquenil on Autoimmune Symptoms
37 years old, female. I apologize for the length of this message; the last couple of years have been quite challenging for me. I have been on a prolonged quest to understand the issues my body is facing. Back in July 2023, I began working as a registered nurse on a bustling medical-surgical floor. The adjustment period was tough, and my anxiety levels soared, which led to an unbearable itching sensation. I tried switching laundry detergents and soaps, but nothing seemed to alleviate my discomfort. In hopes of finding a better routine, I moved to the night shift, yet this change offered no relief. By the time I resigned in May 2024, I was experiencing suicidal thoughts, rashes, hives, and persistent diarrhea, which I initially attributed to my gallbladder removal. After taking a few weeks off, I transitioned to a position as a hospice nurse, and my condition significantly improved. However, once my caseload increased to maximum capacity, the itching returned, becoming intensely bothersome again. I developed new rashes and hives, particularly around my joints, which would vanish quickly. Alongside these symptoms, I faced chronic diarrhea and stomach issues. During these episodes of itching, it felt as though my entire body was underpins of needles—prickly and cold. One of my knuckles swelled, causing pain and discoloration, while my right leg and knee also became swollen and painful. An X-ray showed fluid in my knee, and my knuckle remains discolored, although hand X-rays were unremarkable. My previous primary care physician suspected mastocytosis and referred me to both an allergist and a rheumatologist. Unfortunately, my experience with Cromolyn sodium was unhelpful. After conducting blood tests, the allergist found a positive antinuclear antibody (ANA) result. When I brought this to the rheumatologist, I underwent a series of tests, all of which returned negative except for a second positive ANA. The nurse practitioner handed me a prescription for Plaquenil, told me everything appeared normal, and scheduled a follow-up in three months. Feeling the need for further answers, I made an appointment with a dermatologist. After running several tests, she identified two positive occult blood results (an EGD is on the horizon) and noted that my DHEA levels were consistent with those of a post-menopausal woman. Additionally, she observed low globulin levels and referred me to oncology. The oncologist, puzzled by the referral, listened attentively as I explained my symptoms. He took considerable time with me, validating my concerns more than others had, and recommended I pursue treatment at the Mayo Clinic. He also conducted additional blood work. The laboratory results highlighted only low IgA levels. While my previous rheumatology assessment indicated low normal IgA levels without deeming them abnormal, I have a follow-up scheduled with him tomorrow and another with rheumatology on Friday. In January 2025, I changed jobs again as the stress was overwhelming; depression hit hard, and my anxiety levels were through the roof, exacerbated by my 70-hour work weeks and recurring suicidal thoughts. After experimenting with various mental health medications with no success, I sought relief through regulated ketamine therapy, which has provided me with some respite since December. My condition has gradually improved since shifting jobs, though I've started to experience moderate itching again during busy weekends, alongside daily diarrhea which persists; my gallbladder removal occurred in 2023, and I've been dealing with dry, burning eyes intermittently. Recently, I missed taking Plaquenil for about a week, and today I've noticed my hands becoming stiff once more. One knuckle is painful and appears swollen. I have several queries: 1. Is it possible that there are autoimmune issues at play that are undetectable in my lab results? I recognize that a positive ANA test is not definitively indicative of a specific condition, as evidenced by my two positive results. 2. Could the hiatus from Plaquenil for a week spur the reappearance of autoimmune symptoms? 3. Would the recurrence of symptoms upon pausing the Plaquenil suggest some validation of an underlying autoimmune issue? While I hope there's nothing seriously wrong, it feels like my body is rebelling. I struggle to handle stress, yet my job inherently involves it. I attend therapy weekly. Most of my labs return within the normal range, but I continuously feel unwell. Medical History: C-section in 2011; underwent gastric sleeve surgery in 2020 (resulted in a 130 lbs weight loss); cholecystectomy in 2023. Current Medications: - Primidone 50 mg BID (for tremors) - Propranolol DR 80 mg QD (for tremors) - Wellbutrin 300 mg QD - Claritin 10 mg QD (for itching) - Buspar 30 mg twice daily - Protonix 40 mg QD (for stomach issues) - Plaquenil 200 mg 1 1/2 tablets QD (trial from rheumatology) - Lamictal 200 mg QD (for mood) - Cetirizine 10 mg QHS (for itching) - Fexofenadine 180 mg QHS (for itching) - Minoxidil 2.5 mg (half a tablet QHS for hair loss, which I've experienced for almost two decades) - Temazepam 15 mg QHS (for sleep) - Trazodone 100 mg QHS (for sleep and depression) - Ketamine 400 mg troches twice weekly and IV infusions as needed. - Daily multivitamin and DHEA supplement.
Answers (1)
3/26/2025, 2:50:57 PM
OpenHealth AI
It's understandable to feel overwhelmed by the complexity of your symptoms and medical journey, especially with your busy job as a nurse and the stress it brings. Let's break down your concerns regarding your health situation and the missed Plaquenil dose.
Key Points:
- Autoimmune Conditions: There are indeed autoimmune issues that may not always show up in standard lab tests.
- Plaquenil Interruption: Missing Plaquenil for a week can potentially lead to the recurrence of symptoms, especially if it was helping manage your autoimmune condition.
- Symptom Recurrence and Validation: The return of stiffness and swelling may suggest that your autoimmune symptoms are linked to inflammation that Plaquenil was mitigating.
Explanation:
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Autoimmune Concerns: A positive ANA test can indicate various autoimmune issues, but not all conditions are easily detectable through lab tests. Conditions like lupus or other autoimmune diseases may have symptoms that occur without definitive laboratory indications. It's essential to continue discussing your symptoms with your rheumatologist and guide your treatment based on your clinical presentation and follow-up findings.
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Impact of Stopping Plaquenil: Plaquenil is often used to manage autoimmune diseases by reducing inflammation and immune response. Skipping it for a week can allow your immune system to become more active again, which may explain the stiffness and swelling you are noticing in your hands.
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Symptom Recurrence: The resurgence of symptoms after pausing medication could provide insight into the role of Plaquenil in your treatment. This doesn’t confirm an autoimmune diagnosis by itself, but it does suggest that your condition may be stable while on the medication.
Actionable Next Steps:
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Reinstate Plaquenil: If you haven’t done so already, resume taking Plaquenil as prescribed. Discuss with your rheumatologist the best course of action if you have been feeling worse since missing doses.
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Monitor Symptoms: Keep a detailed symptom diary that includes when symptoms flare, their severity, and any potential triggers. This information can be helpful for your healthcare team to determine patterns and possible connections to your treatment.
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Communicate with Your Healthcare Team: Talk about your concerns and recent symptoms during your upcoming rheumatology and follow-up appointments. Ensure they understand the impact of your symptoms on your quality of life and work.
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Self-Care Strategies: Focus on stress management techniques such as scheduled breaks during work, mindfulness practices, or gentle physical activities like yoga, which could help alleviate some stress and potentially improve your overall well-being.
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Follow-Up on Other Symptoms: Discuss the ongoing issues like diarrhea, eye symptoms, and any other new changes with your healthcare provider. These may require a collaborative approach involving different specialists.
Remember that you're not alone in this journey, and feeling unheard can amplify your struggles. It’s commendable that you are seeking help and exploring various treatment options. Be sure to advocate for yourself in your medical care, and take one step at a time for your health.
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