diflucan mechanism of action

Medication works but confusing test results

QUESTION:

I was diagnosed with Sjogren's Syndrome over a year ago when I went to my GP
with severe fatigue, muscle weakness, gi issues, and costochondritis. I had no
dryness issues to speak of but my test results came back with positive ANA and
SS-B.  I've had very little success in feeling better after 6months on
Plaquenil.  I feel better during Medrol tapers though.
My questions are: Are many people diagnosed with Sjogren's despite having not
having issues with dryness?  How closely related are Sjs and Lupus symptoms?
Being that long term steroid use is out of the question, is there anything that
may help me more than Plaquenil?  Thank you for taking the time to read this Dr.
Carteron.

ANSWER:

You are welcome.   As many as 40% of patients diagnosed with Sjs may not have dryness at the beginning of their illness. Most will get it to some degree during it and should work closely with their dentist for preventive measures. But without the dryness, it is harder to get a diagnosis-so great job on your doc's part!

Given that you respond to Medrol-supports there is an ongoing inflammatory/autoimmune process that is reversible. I have used higher doses of Plaquenil, like 600 mg/d, for short periods (and with close eye f/u) with benefit. Your doctor may not feel comfortable with this, as it is not "commonly done". But I discuss the risk/benefit with the patient and we move forward together.

Depending on the risk/benefit discussion, and your and your doctors comfort level, other stronger DMARDs can be considered llike CellCept. Sometimes even using them for around 3 months and then tapering off can help lower the overall activity.

Hope this helps, and let us know which path you choose.

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