How does Plaquenil Work ?

[katieb]

Hi,

I know quite a lot of us are taking Plaquenil (hydroxychloroquine) for RA, often in combination with AP.

I started taking it in November 2010, with clarithromycin (for RA/Lyme).

The dr who prescribed it said it was an ‘anti-malarial’, but that does not mean it is an antibiotic does it ?

It’s also accepted by traditional rheumatologists as a treatment for RA.

Does anyone know what it actually does/ how it is meant to work. I haven’t noticed ANY effects from it so far, good or bad 😕

Thanks ! Katie 🙂

[Maz]

Hi Katie,

I’m currently taking plaquenil for Lyme/babesiosis. There is conflicting Lyme research on its effects on the cystic form of Lyme now. Originally, Brorson (Norwegian Lyme researcher) concluded plaquenil was an effective cyst-buster and now, Eva Sapi, a researcher here in CT at New Haven Uni has presented some info that conflicts with this. Go figure! 🙄

http://www.ncbi.nlm.nih.gov/pubmed?term=brorson%20borrelia%20plaquenil%20

http://www.lymeneteurope.org/forum/viewtopic.php?f=5&t=2776

Nevertheless, it is an effective anti-protozoal anti-microbial (malaria and babesiosis are both protozoan infections causing relapsing/remitting febrile-like illness amongst other symptoms). While Lyme docs won’t use anything immune-suppressive and the jury is still out on why plaquenil works, there is some info on Wiki how how it is thought to modulate and ameliorate the inflammatory process:

http://en.wikipedia.org/wiki/Hydroxychloroquine

“While hydroxychloroquine has been known for some time to increase[1] lysosomal pH in antigen presenting cells, its mechanism of action in inflammatory conditions has been recently elucidated and involves blocking the activation of toll-like receptors on plasmacytoid dendritic cells (PDCs). Toll-like receptor 9 (TLR 9), which recognizes DNA-containing immune complexes, leads to the production of interferon and causes the dendritic cells to mature and present antigen to T cells. Hydroxychloroquine, by decreasing TLR signaling, reduces the activation of dendritic cells thus mitigating the inflammatory process.

Hydroxychloroquine is also widely used in the treatment of post-Lyme arthritis that can be induced by Lyme disease. The action of the drug may involve both an anti-spirochaete activity and an anti-inflammatory activity, similar to the treatment of rheumatoid arthritis.[2]”

To understand the medical-speke in this link, it might be helpful to watch this short video-clip on Lyme and how it is recognized by the immune system, but still manages to evade immune surveillance.

http://envita.com/sections/disease/lyme/default.aspx

Plaquenil can take a good 3 to 5 months to reach full effect.

Yes, it is a conventional rheumatological drug…thing is, it’s not really immune-suppressive as LLMDs wouldn’t be using it otherwise…just immune-modulating to some degree…probably it’s greater effects are as an anti-protozoal med…kind of interesting, eh? Sulphasalazine is similar in that it also has some anti-microbial effects…gotta wonder. 😉

[katieb]

Hi Maz,

Thanks for all the info – sounds like the jury is out – but now I think I know why I was confused 😕

You’re right – gotta wonder !!

It is so great that you manage to keep all this info at your fingertips.

Thanks so much 😀

Katie

[nord]

It’s been included in my medication plan by the LLMD as well. It seems it increases some drugs concentration in the cells, e g the tetracyclines. That explains the results by Sapi et al (as Borrelia defends itself by conversion into the cyst form, same happens for Cpn).

That it increases the conversion into the cyst form for Borrelia is not necessarily a bad thing, if there is a good way to kill the cysts (possibly Nitroimidazoles). That’s the thinking behind the Cpn CAP.

For Cpn, it has the additional benefit of countering porphyria (secondary porphyria is one of the effects of Cpn, and can be triggered by treatment. Its not included in the Cpn CAP, but I wonder if I have had such an easy time with the treatment by including it?

[Fkendall]

I take it daily for three to four weeks a month between my AP treatments. My RA count was down and I tried to stop the Plaquenil, the pain immediately got worse, so I am sticking with it.

[Author]

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