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Auto Immune Disorder
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Auto Immune Disorder

I have an Auto Immune Disorder of the connective tissue as labeled by my Rheumatologist.  I take Plaquenil 200mg, and Arava 20mg daily.  I have been on the Plaquenil for over a year and the Arava for 5-6 months.  I am still having flares and experiencing pain on a daily basis.  I'm a 28 year old male.  My tested positive for ANA but the doctor hasn't labeled me with Lupus.  I see my Rheumatologist on the 18th of December and I'm looking for the next step in my treatment.  Do you have any suggestions for what I should talk to my doctor about when I see her?  Possible treatments (Humira, Cymbalta etc.)  Thank you!
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Although Plaquenil was developed and has been used to treat certain infections like Malaria, its use in certain autoimmune diseases is not understood. It can reduce skin problems in lupus and prevent swelling/pain in arthritis-like conditions, though it is not known exactly how the drug works on autoimmune diseases.   My guess is that it treats one or more chronic infections that are present.

Arava is a pyrimidine synthesis inhibitor that is used in the treatment of Rheumatoid Arthritis. It is thought to work by blocking certain enzymes responsible for abnormal tissue development or growth.

If you respond to anti-infectives like Plaquenil, you could have a chronic infection like Mycoplasma.  These are often found in connective tissue and joint autoimmune conditions.  

If you have a Mycoplasma or other chronic infection, then you might respond to anti-infective drugs like oral doxycycline given long-term (These infections are difficult to suppress in the usual short-term courses of treatment that most physicians favor).  In cases like this it is usually better to add the additional antibiotic, rather than substituting for the Plaquenil.
Prof. Nicolson
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