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MS

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MS, Multiple Sclerosis usually affects those who live in the colder northern countries. I was born in the border town of Fort Covington, just a walk down the street to Canada. And then I grew up in another nearby border town. In the winters our temperature dropped below freezing and stayed there until March.  My mom was Irish and my dad French Canadian. My brother was just like me.

MS usually starts somewhere between 20-50 years. Just like RA there is an elderly onset MS striking those age 60 and above. Children also develop MS.

MS is an autoimmune disease where the T cells of our immune system think the cells of the myelin sheath, the nerve covering, is foreign and must be attacked. This arbitrary attack affects the brain, spinal cord and the optic nerve and creates a a variety of symptoms. More women than men have MS. Genetics play a role.

MS interrupts the flow of information within the brain and between the brain and the body. Walking becomes difficult. Hands may lose their grip. Skin may itch. There may be bladder issues. Vision may become blurry. There is a wide range of symptoms depending what areas of the nervous system are affected.

While there is no cure for MS, there are medications and treatments that relieve symptoms.

The National Multiple Sclerosis Society has an excellent web site with helpful information.

 

Mary Man's RA Journal Icon

Disabling RA

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One of the big pleasures I have is watching the full moon make its way up and over the mountain. I see it from my patio doors as I am making dinner. Lately, it not only is a big, full moon but also a beautiful, warm yellow. When I first see it, the moon  is just peering over the top edge of the mountain. Then it seems to sit on the edge of the mountain top just before continuing  its journey up into the night sky. A moment in time.

I was thinking of good things to distract from the pain I have in my joints and the nagging fear in the back of my mind that I am becoming more disabled with each passing day.

My RA was diagnosed seven years ago in January. Since then, I have had three cancers and a hip replacement. Most of that time I have been on methotrexate, mostly injectable. It has slowed the progress of the RA. It could be worse. I’ve been on almost all the biologics. Currently, I am two doses into another drug called Actemra. It will help, but it will probably be paused as I now have a new complication from past breast cancer radiation.

As I type, my right wrist hurts as do both hands. Wrist pain used to come and go but it is here most of the time now. My ankles hurt as well as do my feet. Fortunately for me, I am a two finger typist since my hands are misshapen and can no longer use the correct typewriting form I learned in high school. I could go on but those who have RA or any of the other autoimmune or inflammatory diseases will understand.

Pain is manageable to some degree. Ignored. Medicated. Fearing an uncertain future is not as easy. My degenerating arthritic feet and spine require that I use a cane. I can no longer drive. No, it is not easy. And no, it can’t be rationalized. It is what it is.

I write it down. I continue to live. I am fortunate that I can spend my time on my favorite activities, reading and writing. And amazing enough I am happy.

Journal

November 2019

Meet Ankylosing Spondylitis (AS)

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Spondylo means vertebrae or bones in your back. So, you can see that AS affects the spine. With the progression of disease, the vertebral joints fuse causing the spine to be stiff.

AS affects the areas where the joint capsules, tendons and ligaments attach to the bones. Pain and swelling occur along these “hotspots”. The lower back, the sacroiliac joints, the cervical spine, pelvic bones, the rib joints and the heel. Classic AS involvement.

Many other joints can be involved. The joints of the hip, shoulder, and knee are commonly involved. Involvement of fingers, toes, wrists and jaw, although possible, is not common.

It is a disease of younger people (teen-40s) usually. It is common in men, but science is learning that women have AS frequently, too. It is a major cause of low back pain.

It is an inherited disease. There are many genes involve. The gene HLA-B27 is present in 90% of those who have AS. As in many cases an environmental trigger like an infection activates the genes involved.

AS belongs to a group of inflammatory, arthritic diseases including psoriatic arthritis, reactive arthritis and enteropathic arthritis. This group is called spondyloarthritis (SpA).

AS is the second leading inflammatory arthritis behind RA.

Expanding your horizon

Visit the Spondylitis Association of America website to learn more.

Creaky joints has a good article on women and AS.

Silica is a risk factor for rheumatoid arthritis

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Silica, the earth’s most abundant mineral, is made up of oxygen and silicon. It is a part of many, many processes including mining, pottery making, glass making, and granite work including tombstone making. The lung disease caused by crystalline silica dust is called silicosis and has been known since the time of Hippocrates. It is an inflammatory disease.

In the fifties after many studies, it was learned that autoimmune diseases including rheumatoid arthritis could be caused by exposure to crystalline silica. The connection though proven is not well understood. Rheumatoid arthritis is also an inflammatory disease.

This morning I was reading one of the comments on the forum Health Unlocked. It was written by a woman who has RA as does her brother. Interestingly, both had jobs where they worked with silica.

My Journey with Orencia

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I published this series of posts during the year I was on Orencia. The following are my experiences.

August 2015-August 2016

Tomorrow, I have my first infusion of Orencia. It is a biologic used to relieve symptoms and slow the joint destruction of Rheumatoid Arthritis.

I have just read the medical insert for Orencia. The studies are hopeful. (Having statistics in college finally pays off.

The infusion will take 30 minutes. My son is going with me. He is good company and a morale booster. In two weeks, I will have another infusion. At one month I will start infusions monthly. I will be happy to have the infusions as long as they help.

I have read endless online comments of those who have taken Orencia. They have met with success for the most part. Success means less pain, less disability. It means more energy. It means more life.

Orencia, after three months

I knew Orencia was working for me one week after my first infusion. Swelling in my hands, ankles and feet gradually disappeared until at three months I only have minor swelling in my hands. My daily dose of RA pain has subsided to mostly feet pain, occasionally hand pain and spine pain. My improvement is amazing and feels like a miracle.

It feels like a miracle because I had been in uncontrolled RA pain since the Fall of 2012. Now in the Fall of 2015, the pain is almost gone. Thanks to Orencia my RA fog is lifting. I have more energy. And I will have a lot more energy as I move more.

I am still on other medications for my RA. I am on Methotrexate injections. I take Plaquenil, meloxicam, gabapentin.  My prednisone is 2/3 of original dose and decreasing.

I go to the infusion center once a month. Time is about one hour. Occasionally, I have what feels like a rebound effect. About a week after the infusion, I have a day or two of inflamed joints. Then it’s gone.  Then it’s good.

Orencia is expensive. My insurance co-pays maxed out, so I have no more co-pays until the beginning of next year.  I do have an Advantage Medicare insurance program so am not eligible for financial assistance from the Orencia drug assistance programs.

I had the expectation that this drug would work. I have no idea why except that nothing had worked up until this medication. I am glad it works.

Hopefully, my experience will give you a little optimism. Eventually, you will find something that will work for you too.

Orencia Seven Infusions

Next week I will have my 8th Orencia infusion. My time in the infusion center is about an hour. It is usually uneventful.  I am given benadryl, pepcid and another little pill I was told was for allergies. Blood is drawn for inflammation markers, C-Reactive Protein and SED rate, metabolic panel and CBC.

Since I have been having the infusions, my neutrophils have become normal. My joint swelling has been greatly diminished. My pain levels have been reduced.

I do have a weird cough. It is weird because when I enter a space away from home, I start coughing. It goes on for a bit and finally comes under control. Sometimes I feel like I have the flu, but I don’t.

I still don’t have as much energy as I would like. I do have some RA problems. Still, I am better than I was before the Orencia.

I went to a number of online communities to see what others were experiencing with Orencia. There were many miracles. Good results. There were some with the same cough, flu like response that I have. There was one who went into anaphylactic shock on her 17th infusion. There were many who had serious problems with headache. There were some who had rash and itching problems.

I also read several studies on Orencia. I am also on methotrexate injections.

The results of the study at six months:   67% had a 20% improvement in symptoms; 45% had a 50% improvement; and 14% had a 70% improvement.

So a 100% improvement doesn’t seem likely.  So, the expectation might not be a miracle but a good improvement in symptoms.

August 2016

My flares are getting worse. I have come down with a horrific flu. It is the worst that I have had in years. Dr Reiter agreed that it was time to stop the Orencia infusions.  I had good results for over nine months. I wish it had lasted longer.

Learn about RA Drug Orencia

 

More About RA Drug Orencia

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Orencia Abatacept

Abatacept, trade name Orencia, is a biologic medication for rheumatoid arthritis. Ads for it have been on tv.  It reduces the inflammation that causes some of the symptoms of RA. It is also used for adult psoriatic arthritis and juvenile idiopathic arthritis.

Response to expect                                                                                                                According to clinical trials of Orencia use, up to 75% of patients had a 20% improvement at six months. About 50% had up to a 50% improvement. About 13% had a 75% improvement. In these studies, methotrexate was also being given.

Pill, shot or IV?                                                                                                                        Abatacept is a large molecule which means that it would not be absorbed into the body if taken by mouth. It is administered by injection under the skin subcutaneously. It is a similar process that a diabetic uses when administering insulin in a syringe. Abatacept comes in a prefilled syringe and it also comes in a Clickjet which is an autoinjector. It must be kept away from the light and stored under refrigeration until 30-45 minutes before use. It is also administered intravenously(IV) in a medical facility. Both methods are effective.

In preparation                                                                                                                          A TB test is required. Tests for hepatitis B are also given. It is recommended that the newer shingles vaccine, Shingrix, be given. It is given in two doses over two to six months apart. It is not live so may be given before or during Abatacept use. A flu vaccine is also recommended which is also not live.

Pregnancy and lactation                                                                                                                   

Effects of Orencia on the fetus during pregnancy and in breast milk are unknown.

Common side effects                                                                                                            The most common side effects of Abatacept are upper respiratory infections, such as common cold and sinus infection, sore throat and also headache and nausea.

Black box warning                                                                                                                  There is no black box warning for Abatacept.

Serious side effects                                                                                                                    Infection is potentially a serious and common complication of the biologic medications. The biologic medications depresses the immune system. Abatacept is no exception. The most common serious infections involving Abatacept are pneumonia and sepsis. The following is a quote from the Abatacept drug insert: “Some of these infections have been fatal”. Severe allergic reaction has occurred. Hepatitis B virus reactivation is a possibility. Before starting on Abatacept, a person should be given tests for the hepatitis B virus. COPD patients on Abatacept have more adverse events than those without COPD.

Cost                                                                                                                                         Four prefilled syringe of 125 mg of Abatacept without coverage would cost about $4500.00 a month in 2019 according to goodrx.com and wellrx.com. It is similar in cost to Actemra. It is hard to assess insurance copays as they are different in the various insurance plans. There can be no generic drug for Abatacept. The drug is made from a live cell not a chemical formula that can be duplicated. There is not a biosimilar for Abatacept. A biosimilar is a drug that is made in a similar but not exact same way as the original. There are a few RA biologics that have biosimilars. The difference in cost is not huge.

History                                                                                                                                        Abatacept was developed by the American pharmaceutical Bristol-Myers Squibb. It was FDA approved in 2005 for RA.

Action                                                                                                                                          Orencia is a selective co-stimulation modulator. Orencia works by inhibiting the action of the T cells. It interferes with the early stage of the inflammation process reducing inflammation.

Our immune system has many components. Various biologic drugs have been designed to affect individual overactive factors in our immune systems. Actemra affects IL-6.  Humira and Embrel affect TNF (tumor necrosis factor). Orencia affects T cells. Rituxan affects B cells. Each are designed to suppress a particular overactive molecule in our immune system.

Do not be discouraged if one immunosuppressive drug doesn’t work for you. Try another.  It might work better. There doesn’t seem to be a test to determine which molecules in the immune system are causing an individual’s RA or which biologic will work best.

Read the drug package insert.                                                                                            Informative. The difficulty of it is thin paper and a small font. The information is helpful.

Visit the Orencia website.                                                                                              It is full of information. Also read the section intended for medical people as well.

RA biologics are magic bullets for many of us. But they come with serious cautions. It is a smart person who checks out the cautions and determines two things. First, she needs to determine what is her individual risk and what she will need to do to protect herself. Second, she needs to weigh her need for relief with the cost of the biologic and with the possible complications. Doctors recommend, but we need to determine what is the right choice for us.

More about RA drug Actemra

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Actemra     Tocilizumab     TCZ

Actemra is a biologic drug used to treat the symptoms of rheumatoid arthritis. It is also approved for giant cell arteritis, polyarticular juvenile idiopathic arthritis (PJIA), systemic juvenile idiopathic arthritis (SJIA) and cytokine release syndrome (CRS).

Response to expect with Actemra                                                                    At 24 weeks of weekly injections, 69% of those with RA had a 20% improvement in symptoms. Additionally, 47% had a 50% improvement and 24% had a 70% improvement. That leaves 31% with no improvement. None of the biologics work for everyone.

Pill, shot or IV? Actemra is a rheumatoid arthritis drug that is a large molecule. What that means is that Actemra would not work as a pill and must be given as an injection. Actemra is given once every two weeks initially. Depending on the response, it may then be given weekly. It is given under the skin subcutaneously. This is the same method used for diabetics giving themselves insulin using a syringe.  Easy and painless. Actemra comes in a prefilled syringe, and it also comes in an ACTpen which is an autoinjector. It must be stored under refrigeration until 30-45 minutes before use.

Actemra may also be given as an infusion which is an IV given in a medical facility over several hours.

In preparation for Actemra. A TB test is required. Tests for hepatitis are also given. It is recommended that the newer shingles vaccine Shingrix be given. It is given in two doses over two two six months. It is not live so may be given before or during Actemra use. A flu vaccine is also recommended which is also not live.

Pregnancy and lactation                                                                                      The effects of Actemra on the fetus during pregnancy or the on the breast milk are unknown.

Common Side effects                                                                                            The most common side effects of Actemra are upper respiratory infections (common cold, sinus infection), headache, increased blood pressure and injection site reactions.

Black box warning                                                                                                This warning for Actemra is given for serious, maybe deadly, infections. Infections may include tuberculosis, invasive fungal infections, bacterial, viral and other infection due to opportunistic pathogens. Infection is a serious problem for those with rheumatoid arthritis.

Additional serious side effects                                                                             Infections must be taken very seriously. A person on an RA biologic will have a compromised immune system. Tuberculosis, if present in the body, may be reactivated. A TB test will reveal the presence of TB. If positive, a person should be treated before starting Actemra. A person with a history of chicken pox should have the new shingles vaccine. Otherwise, there is a risk of shingles. A person with a history of diverticulitis should pay attention to new abdominal symptoms, as gastrointestinal perforation has occurred while on Actemra during clinical trials. Cholesterol lab values may increase on Actemra and should be monitored.

Cost                                                                                                                             Four prefilled syringes of 162 mg of Actemra without coverage would cost about $4500.00 a month in 2019 at Walgreen’s according to wellrx.com. It is similar in cost to Orencia. It is hard to assess insurance copays as they are different in the various insurance plans. There can be no generic drug for Actemra. The drug is made from a live cell not a chemical formula that can be duplicated. There is not a biosimilar for Actemra. A biosimilar is a drug that is made in a similar but not exact same way as the original. There are a few RA biologics that have biosimilars. The difference in cost is not huge.

History                                                                                                               Interleukin 6 (IL-6) and its receptor components were discovered and cloned by Japanese immunologist, Tadamitsu Kishimoto.  Dr Kishimoto was a successful pioneer in the field of cytokine research and was instrumental in the development of Actemra.

In 2005 Japanese Chugai Pharmaceuticals launched Actemra. Chugai is in an alliance with Roche(Switzerland) and  Genentech (USA). Actemra is sold by Chugai in Japan and Asia, Roche in Europe and by Genentech in the USA. In 2010 the FDA approved Actemra for rheumatoid arthritis. It was approved for children with polyarticular juvenile idiopathic arthritis in 2013 and systemic juvenile idiopathic arthritis in 2017. Both are forms of juvenile RA.

Action                                                                                                                IL-6 is produced by synovial and endothelial cells in the joint and contributes to the inflammatory process. Actemra is a humanized interleukin-6 receptor-inhibiting monoclonal antibody that suppresses the inflammation activity of rheumatoid arthritis. As a targeted drug, Actemra may be a magic bullet for someone suffering with rheumatoid arthritis.

Our immune system has many components. Various drugs have been designed to affect individual overactive factors in our immune systems. Actemra affects IL-6.  Humira and Embrel affect TNF (tumor necrosis factor). Orencia affects T cells. Rituxan affects B cells. Each are designed to suppress a particular overactive molecule in our immune system.

Do not be discouraged if one immunosuppressive drug doesn’t work for you. Try another.  It might work better. There doesn’t seem to be a test to determine which molecules in the immune system are causing an individual’s RA or which biologic will work best.

It is good to review the package insert for the drugs you are taking. It looks more complicated than it is and worth the effort. The drug’s website also has helpful information about the drug.

RA biologics are magic bullets for many of us. But they come with serious cautions. It is a smart person who checks out the cautions and determines two things. First, she needs to determine what is her individual risk and what she will need to do to protect herself. Second, she needs to weigh her need for relief with the cost of the biologic and with the possible complications. Doctors recommend, but we need to determine what is the right choice for us.

Stronger with exercise

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October 2019

I am amazed that I feel so much better. It has been a gradual process, a yearlong process. Recovery from the treatment of a rare uterine cancer is long, discouraging at times and scary at others. I say scary because the fatigue and the use of a brain that seems murky and sluggish is not something I would want to live with permanently. My fear was that this mental and physical slowness might just be permanent. So, I am relieved, quietly jubilant. My spark has re-ignited and I feel alive again.

I am now able to go to the gym without being worn out for the day. My legs are stronger. I am becoming sturdy. I am reading again. I just finished Educated by Tara Westover and thoroughly enjoyed it. Her evolution from a brain washed, isolated child into a creative, educated and accomplished woman is inspirational.

In the last few months I have found a comfort zone in riding the recumbent bike for 45 minutes three times a week at Planet Fitness. I have more energy to manage my day. I have more endurance. My PF gym is down the road and around the corner from my house. Easy access. The gym is inexpensive, and it accepts Silver Sneakers.

When I regained enough strength to exercise again after my cancer treatment, I returned to the gym where I had been swimming laps. I love swimming. I am an endurance swimmer. Good form. Steady. The smoothness of the water as it passes over my skin feels ever so good when I am swimming. It is a feeling lodged in my mind as a pleasure to be repeated. I swim free style.  Yet, I found that the effort it took for me to travel to the gym, change clothes, swim, shower, dress and travel home too much to keep doing. I stopped exercising. It was simply too much too soon.

My primary doctor recommended the recumbent bike. I was skeptical. But I decided to give it a try. My son thought it was a good idea and he recommended Planet Fitness since it was nearby.

Using the recumbent bike was so much easier to do than pursuing my swimming regimen. It was doable. The adjustment I made paid off. I exercise regularly now.

Since I have joint damage and neuropathy  in my feet from RA, exercise with the recumbent bike doesn’t bother my feet and I am able to get my weekly dose of cardio easily. Walking is not a good choice. Exercise on the recumbent bike builds strong hamstrings and quads. Better to get me through life. It is a good exercise vehicle for the likes of me.

I also noticed as I grew stronger that I was no longer thinking like a sick person. I had been putting limits on myself. These limits started to fade as I grew stronger and moved farther away from the sessions of chemo and radiation. I hadn’t realized what I was doing. But then I probably was weak and infirm at the time.

Eventually I will return to swimming. It is my first love. In the meantime, I will continue on the recumbent bike. I will get stronger and I will add minutes, maybe days. And then, I will add swimming back into my practice when the call of the pool beckons me again.

Elderly Onset Rheumatoid Arthritis

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Blog: EORA, Elderly Onset Rheumatoid Arthritis

As we get older, our youthful bodies start to lose some of the agility and endurance we have always expected of ourselves. We slow down. Late nights aren’t as fun as they used to be. Food choices change. Spicy food may suddenly seem too spicy. Climbing stairs isn’t quite as easy as it once was.

Aging is a gradual process and we adjust to it as we go. Some of us feel lucky to be alive. We have friends and family who have died from cancer or heart disease. We may have the experience of surviving war, illness or accidents. And we have finally learned that we are not immortal. We see the calendar pages fly by and are starting to wonder about the condition of our maturing bodies. We look more closely at our medical insurance plan and we start making appointments with our primary care providers. We are prescribed the classic medications, a statin and maybe  a blood pressure pill. We promise ourselves to walk more and to lose a few pounds. Arthritic changes are more noticeable.

Most older adults have some osteoarthritis in their bodies. We expect to have some arthritis as we grow older. Osteoarthritis is often thought of as a disease of wear and tear. It is considered a local disease where a joint, such as the knee, degenerates and loses function.

In those over sixty another form of arthritis, rheumatoid arthritis, develops in  2 % of the population.  Normally, Rheumatoid Arthritis, the most common form of inflammatory arthritis,  occurs in the 35-55 age group (0.5-1% of the general population). Those who are over sixty-five when they develop RA have what is called Elderly Onset Rheumatoid Arthritis (EORA). It is another surprise for us when we hit our sixties.

Although rheumatoid arthritis affects the joints, it is a systemic autoimmune disease that affects major organs and systems in the body. It is not the same as osteoarthritis.

Women/men occurrence ratio changes to 2/1 as opposed to 4/1 for younger RA patients. So, more elderly men have RA than younger men.

Onset is frequently abrupt with the classic features of symmetrical, swollen proximal finger joints, toes, knuckles, feet, wrists, ankles, elbows. With EORA shoulders might be initially affected. Low grade temperature, flu-like fatigue. The onset of EORA may seem similar to polymyalgia rheumatica (PMR).

PMR is an elderly disease that frequently has an onset of anywhere from fifty to seventy years. Seventy is a common time of onset. It is not seen in young people. Symptoms are similar to EORA, but PMR is not a symmetrical disease and initially may affects larger joints such as the hip and lower spine and it usually includes  muscle pain.

Treatment for EORA is similar to treatment for younger patients with RA. Prednisone may be prescribed as a bridge therapy until DMARDs (disease modifying anti-rheumatic drugs) have time to start working. DMARDs reduce inflammation but also slow the disease process. Methotrexate is the most commonly prescribed DMARD. Side effects include nausea and diarrhea which subside with time. RA drugs range from Hydroxychloquine (Plaquenil) to the biologics such as Etanercept (Embrel). Elderly Onset Rheumatoid Arthritis like its younger version is not curable. It can be managed well with treatment.

Failure to treat RA will result in increased disease activity and eventually irreversible damage to joints.  Having the right diagnosis for your arthritis is important so that you will receive the treatment appropriate for your body.

Acquiring RA as we age adds another layer of coping to a body that is already feeling the effects of time. Managing the disease requires a level of determination to stay well that some have a hard time achieving. It is doable. Life can be good with RA. Newer treatments have changed RA from  a horrifying disease to one that is manageable with good outcomes. Well managed RA  makes life  good again.

Plaquenil and the eye

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I have a question about the drug, Plaquenil, AKA hydroxychloroquine. My interest stems from the book I am writing, Nurse Mary’s Guide to Rheumatoid Arthritis. After reading several additional medical reports about Plaquenil, I realized I needed to look further and to expand its section in the medication chapter of my book.

Another reason for my interest was that I had been taking Plaquenil for six years for my RA.  I was taking it in addition to methotrexate injections and Medrol. I had  also been taking it while I was taking tamoxifen for breast cancer. I no longer take tamoxifen as I developed a rare serous uterine cancer associated with using the drug.

None of my doctors questioned the risk involved in taking both drugs. I also made the mistake in thinking Plaquenil was a mild drug. In fact, it does treat mild RA and more aggressive RA when given in combination with other drugs. The drug itself is not mild.

Hydroxychloroquine was developed as an antimalarial in 1955. It was a refined version with fewer side effects than the widely used drug, Atabrine.  Malaria was a huge problem for soldiers serving in the South Pacific during World War II. Soldiers were pretreated and treated with Atabrine.  The treated soldiers that had rheumatoid arthritis or lupus were shown to also have improvement with their diseases. This association was noted by the medical community. Hydroxychloroquine, Plaquenil, was eventually approved for use in lupus and rheumatoid arthritis patients. Today it is an accepted drug in both of these diseases.

The usual side effects of nausea and diarrhea abate after a month or two on the drug. One of the important complications involves the eye.

The concern is the potential for eye damage.  Irreversible retinal damage has been observed in some patients. Risk factors increase with those who received long term treatment with this drug, those on concurrent treatment with tamoxifen which has been known to induce retinal toxicity, or those with subnormal glomerular filtration rate. For those who have used the drug less than ten years, there is a 2% risk of eye damage. That means that two people in every hundred treated will have eye damage.

Asians more often experience an atypical pattern of retinopathy. It is called pericentral neuropathy. Eye exams need to be extended beyond the macula so that eye damage is not missed.

It is strongly recommended that a base line eye exam is given when a patient starts a treatment plan of Plaquenil. Exam includes examining the eyes for visual acuity, central vision field, color vision, and fundoscopy. The exam, according to the drug manufacturer, should be repeated at least annually on everyone taking the drug. The medical community recommends a baseline exam and then a yearly exam after five years. Those at high risk should receive a yearly exam.

Plaquenil has a long half-life. It remains in a person’s body for eight months.

I no longer take the medication. Plaquenil is an important drug for those suffering with lupus. It is also an important drug for certain types of malaria. I have RA. It is not an important drug for me.

Bibliography

Sanofi-Aventis. Product monograph; Plaquenil. http://products.sanofi.ca/en/plaquenil.pdf.

Shippey III, MD, Eugen Alexander; Wagler, DO FACP FACR, Vanya D.; Collamer, MD, FACP, FACR, Angelique N.;   Hydroxychloroquine: An old drug with new relevance; Cleveland Clinic Journal of Medicine, Volume 85, Number 6, June 2018.

Plaquenil (AvKARE.inc) FDA package insert. MedLibrary.org