I was initially diagnosed with Rheumatoid Arthritis about three years ago. My mom and sister also have this diagnosis. I was taking Plaquenil, Naproxen, Methotrexate, and Enbrel for quite some time, and it seemed to have helped some, but it still wasn't fully under control. Over the last year or so, my rheumy began to question whether it might actually be psoriatic arthritis instead of RA because of the pitting in my nails, and the swelling of my fingers. However, she explained that the treatment was pretty much the same so it wouldn't matter that much which it was. I had read that Plaquenil can cause psoriasis flares, and asked whether we should discontinue the Plaquenil if it was PsA, and she said that it wouldn't' make any difference. So I was still having frequent flares and generally feeling crappy a lot, and she was going to have me switch from Enbrel to Remicade infusions and basically said that if this didn't help she didn't know what would. In the mean time, I failed to refill my Naproxen and Plaquenil on time, so I missed a couple days of those meds until I got the refills. During that time, I felt better than I had in years! I wasn't as weak, sore, or exhausted. I was able to be more active and get more done than I had in a long time! So now I do have the refills, but I'm hesitant to take them again because i've been feeling pretty good and i'm afraid to go back to that. Is it possible that the Plaquenil has just been exacerbating the PsA all this time and causing me to feel so horrible? Could the naproxen be causing the fatigue? Just wondering if anyone had any experience with this? Thanks!
That's really interesting. Here's the thing, the same way as it takes plaquenil or any of these other meds time to start working, it likely takes more than a few days to stop working. I've been taking plaquenil for over 5 years, and it is definitely NOT the cause of my pain and fatigue. It actually doesn't make my small amount of psoriasis any worse either.
The naproxen shouldn't be causing fatigue either. I would definitely call up your rheumy and discuss this with her. There certainly are long lists of side effects and potential side effects, so anything is possible.
There are NUMEROUS reports of Plaquenil exacerbating PsA (and if it exacerbates psoriasis, it exacerbates the arthritis part . Many Rheumys and especially the younger ones will not prescribe Plaquenil under any circumstances for PsA patients because of this fact. The other concern is it also exacerbates a number of (all though fairly rare) eye conditions. The thought with many rheumys is that because eye conditions are one of the more insidious "gifts" of this disease, its best not to add fuel to the fire.
Actually you seeing prednisone used less often (except as a bridge drug) for the same reason as it too exacerbates the disease when one comes off of it.
Somehow I am NOT surprised that your Doc would say that if a switch from Enbrel to Remicade infusions didn't help she didn't know what would. With 20 year old thinking on Plaquenil, she apparently isn't aware there are TONS of other options a host of new medications, literally hundreds of different combinations, volumes of research on the almost miraculous effects of various types of exercise and pointed PT. A trip back on memory lane for some old meds is not necessarily a bad thing (although the reason the old meds are replaced with new meds is NOT marketing but rather effect docs make a lot more money on satisfied patients than they do on the rumored (and it is a rumor - trust me I know) kick back from the pharmaceutical companies. Its just that when the potential side effects of a drug like plaquenil out weigh the potential benefits, they quit using it.
If you are unhappy with naproxen, a switch should be pretty easy there are dozens of other NSAIDS and most of us end up changing that component pretty regularly.