Question:
Anyone with Rheumatoid Arthritis using Plaquenil pre and post WLS?

I had a appointment with my rheumatologist today. She is extremely supportive of my decision to have WLS (scheduled for 7/30), but has not had a patient go through it yet. We talked about alternative treatments should plaquenil become a problem post WLS. If you have taken Plaquenil (which for me has been a God-send), please comment on your experience since your surgery. Have you experienced a change in the number/frequency of flares (with an increase possibly indicating a malabsorption of the medication) since your surgery? Has your dosage been able to be reduced following your weight loss? Also, has anyone with RA (or other immune disorder for that matter) experienced flares immediately following surgery? If yes, how were they treated (prednisone has been used to treat my acute flares--not sure that's viable immediately following surgery)? Did you and your surgeon discuss the treatment plan pre-WLS should you experience a flare? Your input will be greatly appreciated.    — lbarbi1379 (posted on June 24, 2002)

June 24, 2002
Hi Linda, I have RA too. I have taken Plaquenil for about 2 years now. My rhuematologist also supported me having the surgery. I had to stop taking it for a week before surgery. And because I was having no pain I didn't start taking it until about 2 months after surgery (surgery was Jan,2002). I have lost 118 lbs since surgery so I am hoping that will help. I am still taking the same dosage as before surgery. He also has me taking Vioxx(surgeon recommended it). But I am only taking that when I have a bad flare up.Which thankfully is not to often. Good Luck with you surgery! Take Care, Toni
   — toni D.

June 24, 2002
Hi Linda, I have been on Plaquenil for about four years now.. had RNY surgery on Feb 20th of this year. I took the medication up until the day of surgery, and resumed about one week post op...There have been no problems at all taking it. The second part of your question deals with whether or not a flare occurred post op... YES, unfortunately I had a flare in the hospital but I felt so crummy anyway who cared?? I did notice that of all the WLS patients on the unit at that time, I was the worst about walking, etc. Didn't help that I also had a couple of complications but I am no worse for the wear, and happy to say that I lost 75 lbs since then... I wish all for you that you wish for yourself, and more! Best of luck, email if you have other questions. [email protected] Ann
   — Ann B.

June 24, 2002
Linda: P.S.... I have Systemic Lupus, not RA... forgot to mention that in the previous post. OOPS!
   — Ann B.

June 24, 2002
I, too, have active RA. I had my RNY on October 17th, 2001. I had to stop taking my meds two weeks prior to surgery (plaquenil and relafin). I HAVEN'T TAKEN THEM SINCE! In December 2001 (6 wks after RNY), I had my left knee totally replaced. It's probable that the weight loss has saved the right one. I still have RA, but can manage now on the ouchy days. I will be seeing my rheumatologist in October (for the first time since surgery) and I doubt he'll recognize me...I'm now 110 lbs lighter than I used to be. I do need to talk with him about future courses of treatment, should it be necessary...I was approved for Enbril, but elected not to start taking it because, overall, I feel pretty good. WLS doesn't cure RA, but the loss of the weight can greatly improve your outlook. Feel free to email me if any questions...by the way, I was the first of my rheumatologist's patients to have WLS - now he refers them to me for information!
   — linmazz

June 25, 2002
I don't have RA, but I was diagnosed with Lupus in 1993. I also take Plaquenil for arthritis. I was able to resume taking it twice a day about 10 days after surgery. This is the same dosage I was taking pre-op. I am allergic to steroids, so have never taken them. I'd be lying if I said I didn't miss the 800mg. of Motrin I was taking 4 times a day. I take Celebrex, which is not anywhere near as effective, but is easier on the pouch. My doctor also allows me to take Vicoden as I need it. I use several non- pharmaceutical methods to control the symptoms and pain also. I take DHEA, a hormone that acts similarly to steroids in the body, do check with your Dr. about this before taking it. I also take omega fish oil tablets. Before surgery I had terrible reflux and couldn't stand the fishy flavor "repeating" itself all day. Now the reflux is gone, so the fish oil is no problem. I use heat on my joints, have you tried the new ThermaCare air-activated heat patches? They are rather pricey for daily use, but they work well. If you have access to a Jacuzzi, they are wonderful! My mother gave me a portable spa as a gift several years ago. I spend 15 minutes in it twice a day. I have even found a way to exersize in it. The added pain and stress the extra weight was putting on my arthritic joints was one of the reasons I decided to pursue WLS. At 290 lbs (and only 5'0" tall) I was at the point where I could barely walk. I work part time as a teacher, so this was causing me great difficulty. I have lost 120 lbs. and it has made a huge difference. The pain in my weight bearing joints (hips, knees, ankles, toes etc.)has decreased by over one half. I can now walk about a mile with no difficulty. The physical stresses surgery and of losing so much weight so quickly did send me into a flare-up. It lasted about 4 months. I did the usual things, more rest, less stress, plus the drugs and supplements listed above. Since I never could take steroids, it made little difference to me. If they have helped you a great deal, you will want to weigh the pros and cons of never being able to take them again as you make your decision about WLS. We all have to carefully weigh the pros and cons before we make this life changing decision. Those of us with Lupus, RA or any chronic disease need to do plenty of research and ask our doctors many questions before deciding if this is the right decision for our lives. It sounds like you have a very caring Dr. who is working closely with you. My Doctors were supportive of my having the surgery. I had an open RNY on September 11th. (that is another story - I was in surgery when the tragedy happened.) I haven't regretted making the decision to have WLS at all. Best wishes to you as you make YOUR decision!
   — Bobbie B.

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