Expert: Dr.Paul Skett - 11/28/2005

Question
My daughter took Minocycline for 18 months with no problems. She had a Hepatitis A vaccine and then 3 days later came down with severe hepatitis for five weeks. She also developed autoimmune response with arthritis in her joints. Blood test are positive for ANA, antihistone, and anti dsDNA antibodies. She does not fit all the criteria for a lupus diagnosis. After three months of prednisone (10 mg.), Plaquenil 200 mg, Naproxin 440 mg., she still has symptoms, but they are limited to mild arthritis. Anti dsDNA antibodies are still present. I am trying to figure out the cause and hope it will just take a little more time to get her immune system back in order. My daughter's rheumatologist wants to put her on Cellcept to get her off the Prednisone. Cellcept is a drug for transplant patients. This drug scares me. Any advice? Thanks.

Answer
Jennifer,

Thanks for your question.

I am sorry to hear of the problems with your daughter.

As you say, CellSept is a drug licensed for use in transplant as is Prednisone - both are immunosuppressants (suppress the immune system) but working by different mechanisms. Both have a set of similar side effects - if you suppress the immune system you make it more likley that the patient will get infections etc. Your rheumatologist, therefore, may be trying to see if another mechanism of damping down the immune response will help your daughter.

Prednisone is not recommended for long term use as it can cause the adrenal gland the stop functioning which will lead to long term problems for your daughter - again, a reason why the rheumatologist is looking for alternatives.

I suggest you talk this over with the rheumatologist and get reassurance about the validity of the treatment.

Hope this helps,

Best wishes,

Paul