Hi Annie,

I can’t thank you enough for taking the time to respond!

Over the last 6 months, my rheumatologist tested lupus anticoagulant, antiphospholipid antibody, creatine phosphokinase, IgG, IgM, TSH, sed rate, SSA, SSB, SCL70, C3, C4, C-reactive protein, rheumatoid factor, uric acid, and ferritin, and did a CBC and metabolic panel (twice). I don't even know what all of those are, but all were normal with the exception of high ANA, low WBC count, low neutrophil count, and slightly low vitamin D levels. I have just started supplementing vitamin D. I don’t know whether my B12 levels were checked, but I already supplement with methylated B12 since I have the MTHFR mutation.

You mentioned that Plaquenil can make MG worse. I started taking a very low dose (100 mg/day) about six weeks ago as instructed by my rheumatologist, with the intent of working up to 400 mg/day. However, within a couple of days I noticed my muscles fatiguing very easily and realized that going up the stairs was leaving me breathless. That’s when my symptoms began, or at least became noticeable to me. I called my rheumatologist and his nurse instructed me to stop taking the Plaquenil and schedule a follow-up appointment. My rheumatologist was confident that the Plaquenil could not have caused my symptoms, especially since I only took 100 mg and for less than a week. He ordered labs to re-check a few things (metabolic panel, CBC, creatine phosphokinase, ANA, and c-reactive protein). Again, everything was normal except ANA, WBC, neutrophils, and vitamin D. He said it would be wise to follow up with my neurologist regarding the muscle fatigue, and advised me to restart the Plaquenil. However, I decided not to restart it until I’d seen the neurologist, and now that he’s ordered additional tests, I’ve decided to wait until those are completed. I would prefer to deal with one thing at a time and don’t want to be taking a new medication while my neurologist is trying to figure out what’s going on. Could the Plaquenil have “triggered” MG, or exacerbated it to the point where it became obvious? Another thing that coincided with my symptoms starting was the summer heat. I live in Colorado and we had a very cool May and June, so our summer didn’t really start until July, which is right when I began noticing the muscle fatigue.

Anyway, thank you again for responding, and I welcome any additional thoughts.