Immunocompromised Health Care Worker with Lupus

Hi there, I am an occupational therapy student with SLE Lupus. I have been deemed 'in remission' but I am still on Plaquenil which has immunosuppressant effects so it is a bit of a concern for me working in health care where I am exposed to a higher risk of infection. I don't want my condition to limit me from doing what I love but at the same time I am aware of the risks and that I have to take extra precaution. Anyone in the same boat as me?

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  • Hi. I was surprised to see you describe Plaquenil/ Hydroxy as an immunesuppressant. I was sure that the reason it is used often in conjunction with drugs such as Methotrexate and Mycophenolate is because it doesn't work by actively suppressing the immune system? Or certainly not very much compared to other DMARDS or steroids.

    Many take it who work in schools and hospitals and when I took it on its own for four months I wasn't required to be monitored in same way as other DMARDS - only eyes needed checking regularly. It is the impact on eyes that concern people on it the most.

    Anyway I came across this - which confirms what I always thought. Hope this reassures you a bit?

    "Physicians and patients consider hydroxychloroquine an immunosuppressant medication for lack of a more accurate descriptor. Perhaps an immunomodulatory medication would be a better term. The mechanism of action of HCQ has not been fully elucidated and is still a matter of debate, but it clearly has been shown to have anti-inflammatory properties mediated through modulation of the immune system. Unlike more potent immunosuppressant agents such as corticosteroids, methotrexate, azathioprine, cyclophosphamide, and rituximab, hydroxychloroquine’s effects on the immune system are subtle and not as profound.

    When we consider effects of medications on the immune system, the two side effects that we are most interested in are whether, by potentially decreasing normal immuno-surveillance, they might increase the risk of infection and the development of neoplasm (cancers). There is no evidence that HCQ increases patients’ risk of getting infections or increases their risk of developing cancer."

    reasonablywell.net/2011/02/...

  • Thank you for the detailed reply and good information! That is very re-assuring and encouraging! :)

  • I'm on Hydroxy was a nurse. I had the same conversation with my employers. I cant say that I caught anything (I worked with kids) that I wont usually. I had flares and had to take usual precautions, but all things considered you are not technically immune supressed unless your doctor deems you to be.

  • Ok that's good to know, thanks! Yes, guess we just have to take the usual precautions and be as safe as we can either way :)

  • I agree it is confusing - when I started on hydroxychloroquine, my rheumy talked about it in the same breath as MMF, and I was quite sure it was an immune suppressant. But that is not correct.

    In fact, Coco has just posted a study which shows that it actually has some protective effect against infection in people with SLE! Have a look at the research paper linked here healthunlocked.com/lupusuk/...

    x

  • Thanks for the information, this is very re-assuring and encouraging. :-)

  • i think part of the confusion is also that people are often on both hydroxychloroquine and corticosteroids at the same time. Hydroxy is not immune suppressing, but steroids are. x

  • Plaquenil is not an immunosuppressant but rather an anti malarial which helps to prevent a vasculitis caused by lupus and it has also been shown to increase the lifespan of people suffering from lupus. It's mode of action is unknown as to how it helps people with lupus, but it is a mainstay treatment for the condition.

    Dr. S. (in the USA)

  • Thanks for the information, Dr. S! That is re-assuring and helps clear out some confusion I had about the medication.

  • I wouldn't worry, I'm on aza, prednisone and plaqunil, I work within a hospital lab and I've been fine so far :) x

  • ...if it's any help I've been less prone to infections since taking hydroxy. Before diagnosis and treatment I was down with flu every year and it always came with laryngitis. Still have throat problems as I have sjogrens but the flu problem is much less. I have mild lupus and hydroxy has suited me very well. I wish you well in your job xxx

  • thank you xx

  • You will be great in health care. Please go for it. Best wishes Kevin

  • Thank you for your encouragement :)

  • Yes I am a nurse and on hydroxochloroquine , Pred and azathioprine and seem to manage ok. I do however tend to keep away from chicken pox etc just as a precaution. I have 2 very young children too so they are ill quite a lot so I'm around germs a lot of the time. I'm sure u will be ok just take the usual precautions, be sensible etc I probably wouldn't advise working on an infectious disease unit or anything ha!

  • Thanks Sara :-)

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