Reversing adverse effect from antibiotic

I was taking Avelox for a sinus infection. On day 12 I developed neuropathy in my left hand. The pain was so great that it woke me up from sleep. I stopped taking this medication. After stopping this medication I developed swelling in all my major joints. The neuropathy did dimish but the swelling continued, I had lab work done and it all proved to be normal. I was put on Prednisone as a taper and I could not take the high dose. I was put on a low dose which I took a few weeks.This controlled the swelling. After stopping the medication the neuropathy and swelling came back. I was put back on the Prednisone and the symptoms were controlled with minimal swelling noted in my hands and wrists. I have stopped taking it again only to have the swelling and neuropathy return. I was sent to a Rheumatologist by my primary MD who confirmed that I do not have Lupus or arthritis.
I am totally frustrated as I have been dealing with this since almost 5 months, I continue to have sweeling on the tops of my hands and neuropathy continues as I am not taking Prednisone.
Any insight into what will reverse the swelling and pain other then possible time?

[Shazia Alam, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

The symptoms and possible risk factors of peripheral sensory disturbances related
to fluoroquinolones – such as  impaired renal function, diabetes, lymp lymphatic malignancy and treatment with another drug known to cause neuropathy. Some of the past studies have indicated that usually symptoms recover after a few weeks.  I would be concerned if there is something else underlying going on or perhaps the antibiotics have unmasked something that was already there priot to starting the medication.  

There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. The EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems

The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved ,weakness. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes (such as in a disease called Charcot-Marie-Tooth, in which there is a family history of sensory neuropathy usually from an early age associated with other clinical features such as high-arched feet), autoimmune problems (such as lupus (SLE), Sjogren's, Churg-Strauss (in which asthma also occurs), polyarteritis nodosa, which affects blood vessels), and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis or monoclonal proteinemia. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles) are involved, leading to sensory symptoms as well as weakness.

The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required.

The same processes that affect large fibers can affect small fibers. For example, diabetes can typically do this.

There are several other possible treatments to neuropathic pain. As with other conditions, medications that were originally invented for other purposes are useful for pain. This is true of neurontin and lyrica which were originally invented for seizures. Lyrica is similar to neurontin but has less side effects and often people who can not tolerate neurontin benefit from lyrica. However it is more expensive.

This is also true for medications such as amitryptiline, which was originally used for depression but is now a mainstay of treatment for neuropathic pain. However, it has several side effects and may not be used in patients with heart problems.

There are several other medications used for neuropathic pain. Other treatment includes physical therapy and swimming which are often more helpful than you might think.

I hope this information was helpful.