Plaquenil or Salazopyrin

[hbell]

I know it is a strange question on this site, but I am still on AP therapy in combination of 15mg MTX/week. My Rheumy wants me to start on Salazopyrin but I have held off to see how the increase of MTX up to 15mg and AP alone will make things better. My AP doc does not like Salazopyrin because of the sulphur content therefore prefers Plaquenil. My own local doc prefers Salazopryrin. I know both drugs have their own possible side effects, but some feedback from anyone who has taken these drugs. My Rheumy still does not know I’m on antibiotics and I have no intention of telling her either. I do not want to take these extra dmards, but I don’t know whether to just increase the MTX again, or just stay at the current dose and add a dmard?

[Maz]

@hbell wrote:

My Rheumy wants me to start on Salazopyrin but I have held off to see how the increase of MTX up to 15mg and AP alone will make things better. My AP doc does not like Salazopyrin because of the sulphur content therefore prefers Plaquenil. My own local doc prefers Salazopryrin.

… but I don’t know whether to just increase the MTX again, or just stay at the current dose and add a dmard?

Hi HBell,

Gosh no – not a strange question here, at all! 😉

This is just my personal take, but if it was me, I would choose plaquenil over adding more methotrexate. I’m currently on plaquenil, which is used in Lyme disease treatments as it is an anti-malarial and hits protozoan infections. It has some nice anti-inflam props, too. Everyone is different in how they respond to various DMARDs, but according to my doc, plaquenil has fewer side-effects than other commonly-used DMARDs, none of which guarantee the prevention of joint damage…they may slow it, but won’t necessarily prevent it, and just mask disease symptoms.

Sulphasalazine may be a little tougher on the gut than plaquenil, which although it has some anti-microbial props due to its sulpha content, it is also more hyper-allergenic (to anyone with sulpha allergy), but also may disturb blood platelet levels and gut microbiota more. It has no immune-suppressive effects, like plaquenil, and just helps to lower inflam by interfering with inflammatory mediators in the gut. Lynnie has used sulphasalazine in the past, so she can probably share her experience of this drug with you.

[bonnielou]

I second Maz’ vote for plaquenil. I have been on combination plaquenil/minocycline therapy for 3 1/2 years now and it has worked wonders for me. The plaquenil was a little hard on my stomach in the beginning, but I got used to it pretty quickly, and we have been able to cut my dosage way back over time — so now I am taking only one 200 mg pill per week — it’s a low maintenance amount.

For a long while I thought I would try to wean off the plaquenil completely, but it has been a pretty benign medication for me. I think your AP doc is on the right track. It’s hard to tell your rhuematologist what to do — but it gets easier with time!

Bonnie Lou

Bonnie Lou
RA 02/07,AP 10/07
Minocycline 200mg MWF; Plaquenil 100mg 3 days/week
Fish Oil, Ubiquinol, Turmeric, Vit C (2 grams) , MultiVit, Magnesium, Astaxanthin, D3 (5000), probiotics and a daily dose of yoga!

[lynnie_sydney]

Heather – yes I used sulfasalazine (Salazopyrin brand name) some years before I found out about AP because nothing else was working for me as an anti-inflammatory – NSAIDS have a tendency not to be effective for Palindromic RA. It did put me into remission for a few years but it takes about 3 months to kick in. However Dr D has told me that the sulfa part of the drug probably did me damage and the antibiotic portion of it was probably what helped. I took myself off it eventually having read about all the effects, especvially on the liver. I had ulcers in my mouth for the first 6 months on it and loose bowels and orange urine for the whole time I took it. If I had to choose today, I’d personally go for Plaquenil, if Lyme was even a possibility of being in the mix. Lynnie

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[hbell]

Maz, Bonnie Lou and Lynnie – thanks for the feedback. It is so reassuring to hear first hand from people who have actually experienced these drugs. I got my blood work back today, which I have taken every two months. Unfortunately my ESR wasn’t on there due to the blood being over 24 hrs old when pathology received it, but I’m pleased to see my CRP is 8 (should be less than 10) and it was 109 last July and has been slowing coming down. However, the RA monster has to remind you every now and then that its alive and well. I presently have a stupid pain in the top of my foot that actually takes my breathe away when I put weight on it (feels like a floating broken bone in there), but this doesn’t happen with every step, so it certainly takes me by surprise. So much so, that I have to watch my ‘P’s and Q’s when out in public. This has been going on for a couple months now. I’m also pleased to say that I do not take pain killers daily, only when needed and that is only in the form of paracetamol. So I should count my lucky stars for where I am at now and when I read other posts this reinforces my fortune.

Maz – thanks for the in depth info re RA in the spine in another post which I can’t find now (and I didn’t have a computer to reply at the time).

Thanks again

Heather

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