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05/14/2020    Robert D Teiteibaum, DPM

Hydroxychloroquine for Inflammatory Conditions or Neuropathy

RE: Hydroxychloroquine for Inflammatory
Conditions or Neuropathy

I have had ankylosing spondylitis for 54 years.
My first attack, came, in textbook fashion in my
late twenties. Basically, you cannot stand up
straight and there is a sciatica fire like pain
that runs around your sacrum and down your upper
legs. My father, who gave it to me, got his
first attack when he was 28. That was in 1941. He
wanted to enlist in the armed forces but spent 6
months in a hospital getting only supportive
care. There were no steroids nor effective NSAIDs
available, nor any blood tests to accurately pin
this down as a rheumatoid variant. He also
developed multiple plantar heel spurs and had the
infamous Gaenslen procedure performed on his
heels where they flap down the entire fat pad
from the posterior heel to gain access to the
spurs which were resected.

Thirty seven years later, I experienced my
first attack during my residency, I took a week
off and since I had an iron stomach, and the help
of effective NSAIDs like phenylbutazone, I was
able to quell the attack and resume a normal
life. Over the years, I have had attacks every
four or five years apart, and if I recognized it
quickly enough, NSAIDs would do the job within a
day or two. Recently, I had an attack that I let
get out of hand and NSAIDs did not do the job.
Worried, and not wanting to get on the Medrol
Dose-Pack/Prednisone bandwagon, I noticed that
hydroxychloroquin (Plaquenil) that has been used
effectively with Covid-19, has also been used for
decades for auto-immune inflammatory conditions
like lupus, and rheumatoid arthritis, and
ankylosing spondylitis--although I was not sure
that it was prescribed that often for that

Recklessly, but in great pain, I
started on Plaquenil 200mg, two q12 3:30
p.m. on Sunday May 3 in my office. I had spent
seven weeks trying all sorts of cold packs,
massage, tens units with interferential current,
an inversion table for 8 minutes daily, and
b.i.d. celecoxib to no effect. And not wanting
to hurt my kidneys any further, I started on
Plaquenil. Four days later, I played Thursday
night tennis with a little pain, but with great
hope. I have continued to improve. This is a case
of one, but I have read over the years postings
from other podiatrists with ankylosing
spondylitis and I wonder what they have done for
the condition. This may be a significant off
label use of Plaquenil.

Another off-label use for the drug I discovered
(I've had some time on my hands) was for
neuropathy. Like my father, then my older sister
and then myself, we all developed non-diabetic
sensory neuropathy in our in our legs and feet. I
have been taking alpha lipoic acid and
benfotiamine for years with great effect and with
little disability. But I have had this for 25
years (started in 1995), and now I am in
unexplored territory, I have what can be called
a stinger in my right great toe that is sensitive
to shoe pressure and sitting positions. The
Plaquenil also wiped out that pain. Following the
idea that one wants to take the least amount of
pharmacueticals as possible I now take one 200mg
hydroxychloroquin daily, prn.

These off-label uses and effects may be totally
idiosyncratic, but you never know. After all, how
many neurologists prescribe gabapentin
(Neurontin) for seizures nowadays, which was it's
original purpose?

Robert D Teiteibaum, DPM, Naples, FL

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