Managing Autoimmune Disease: Do I Need to Continue Medication?

Autoimmune diseases

Hello, Director Gao.
About a year ago, I visited the immunology department due to dry mouth and tongue ulcers.
My ANA titer was 80+, and I started taking quinine (2 tablets a day).
After three months, the titer decreased to 40+.
Due to severe dizziness, I switched to taking quinine (1 tablet a day), but I still experienced dizziness and diarrhea.
The doctor then changed my medication to Seroquel (1 tablet a day).
Since my titer has stabilized, I am currently taking Seroquel every other day.
I have been having blood tests every three months, and my titer has consistently been around 40+ (with one instance of 40-).
I found information online indicating that normal individuals can also have a titer of 40+.
Do I need to continue taking medication indefinitely, or can I try to stop? I would appreciate your advice, thank you!

Chen Xiuxiu, 50~59 year old female. Ask Date: 2019/04/12

Dr. Gao Jiankai reply Internal Medicine

Hello Ms.
Chen, thank you for your inquiry.
Currently, the use of medications for Sjögren's syndrome is less common with the use of salivary stimulants, and monitoring disease activity is less frequently done with ANA titers.
It is recommended that you consult a rheumatologist for further evaluation.
As for the possibility of discontinuing medication, it should be determined by a physician who has personally assessed the patient's health status and disease activity.
We suggest discussing this with a rheumatologist before making any decisions regarding medication cessation.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is here to support you.

Reply Date: 2019/04/12

More Info

Managing autoimmune diseases can be a complex and nuanced process, particularly when it comes to medication management. In your case, it appears that you have been diagnosed with an autoimmune condition that has led to elevated ANA (antinuclear antibody) levels, which can indicate the presence of autoimmune activity. You have undergone a series of medication adjustments, starting with quinine and then transitioning to Salazopyrin (Sazal), with your ANA levels fluctuating but remaining relatively stable.

The question of whether to continue medication or consider tapering off is one that should be approached with caution and ideally in consultation with a healthcare professional, particularly a rheumatologist or a specialist in autoimmune diseases. Here are several factors to consider:
1. Disease Activity and Symptoms: The primary consideration in managing autoimmune diseases is the level of disease activity. If your symptoms have improved and your ANA levels have stabilized, this may suggest that the disease is under control. However, it's important to assess not just the ANA levels but also any clinical symptoms you may be experiencing. If you are asymptomatic and feel well, this may support the idea of reducing or discontinuing medication.

2. Risks of Stopping Medication: Stopping medication can lead to a resurgence of symptoms or disease activity. Autoimmune diseases can be unpredictable, and while some patients may experience prolonged periods of remission, others may have flare-ups after stopping treatment. It is crucial to weigh the potential risks of stopping medication against the benefits of continuing it.

3. Monitoring and Follow-Up: Regular monitoring of your ANA levels and clinical symptoms is essential. If you and your healthcare provider decide to taper off medication, it should be done gradually, with close follow-up to monitor for any signs of disease reactivation. This may involve more frequent blood tests and clinical evaluations.

4. Consultation with a Specialist: Given the complexities of autoimmune diseases, it is advisable to consult with a rheumatologist who can provide a comprehensive evaluation of your condition. They can help interpret your ANA levels in the context of your overall health and guide you on the best course of action regarding medication.

5. Lifestyle Factors: In addition to medication, lifestyle factors such as diet, exercise, stress management, and adequate sleep can play a significant role in managing autoimmune diseases. Some patients find that making positive lifestyle changes can help reduce symptoms and improve overall well-being.

6. Patient Education: Understanding your condition and being informed about the potential implications of medication changes is vital. Engaging in discussions with your healthcare provider about your concerns and preferences can lead to a more personalized treatment plan.

In summary, while it may be tempting to consider stopping medication due to stable ANA levels and improved symptoms, it is essential to approach this decision thoughtfully and in collaboration with your healthcare provider. Regular monitoring and a comprehensive evaluation of your health status will guide you in making the best decision for your long-term health.

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