Weight changes can be alarming when you’re living with a chronic illness like lupus, and pinpointing the cause can be difficult. Sometimes a long-term condition can bring weight gain or loss, and other times a medication that treats it may be responsible.

Hydroxychloroquine (sold under the brand name Plaquenil) is a common treatment for systemic lupus erythematosus, discoid lupus erythematosus, and rheumatoid arthritis. This medication is known as a disease modifying antirheumatic drug (DMARD) — it treats disease by affecting immune system activity.

MyLupusTeam members have discussed whether hydroxychloroquine can cause weight changes. One member asked, “Weight loss/gain — caused by lupus or Plaquenil?”

Hydroxychloroquine Side Effects

Weight gain is not a reported side effect of hydroxychloroquine. That said, some of its side effects could be associated with weight gain.

Mood changes and depression are known side effects of hydroxychloroquine, and weight gain can be a symptom of depression. The reason for this connection is not fully understood, but researchers have found a link between depression and emotional eating. If someone taking hydroxychloroquine experiences new or worsening depression, it’s important to be aware of the potential for weight gain.

Fatigue — very low energy — and muscle weakness are other reported side effects of hydroxychloroquine. Lack of energy is also a symptom of depression. Fatigue and weakness can make it difficult to exercise, increasing the risk of unwanted weight gain.

For some people, weight loss can also be a symptom of depression. Weight loss also may be associated with some common hydroxychloroquine side effects, such as nausea and diarrhea. Although these symptoms are usually short-lived, they can lead to weight loss and appetite changes.

If you have nausea and diarrhea for an extended period while on hydroxychloroquine, talk with your doctor. Also let them know if you’re noticing hearing changes or hair loss, two other common side effects of hydroxychloroquine.

Serious Side Effects

Depression, fatigue, and muscle weakness are considered serious side effects of hydroxychloroquine. If you develop these symptoms, get immediate medical advice from a health care professional. Other serious side effects of hydroxychloroquine include:

• Abnormal heart rhythm
• Retinopathy (an eye problem that causes blurred vision and blindness)
• Skin reactions

The skin reactions range from psoriasis, which causes itchy patches, to Stevens-Johnson syndrome and toxic epidermal necrolysis, which cause skin cells to die and peel and can be life-threatening. It’s important to notify a doctor immediately if you experience these side effects.

Weight Gain and Lupus Management

Unlike hydroxychloroquine, other lupus treatments are well known to cause weight gain. Lupus itself may also cause weight gain.

Corticosteroids

Corticosteroids work by preventing inflammation and decreasing the immune system’s activity. These drugs also affect metabolism — the body’s chemical reactions that break down and build substances needed for life.

Corticosteroids — in particular, prednisone and methylprednisolone — are associated with weight gain, and the likelihood increases with the dose and duration of treatment. Although corticosteroids can reduce flares, people living with lupus have reported feeling emotionally distressed by body weight side effects.

Antidepressants

An estimated 15 percent to 60 percent of people living with chronic illness will experience depression. Lupus is no exception — the chronic pain it causes can lead to depression, and antidepressant drugs may cause weight gain.

If your doctor is prescribing an antidepressant for you, ask if it is associated with weight gain. Some antidepressants are more likely than others to have this effect. Paroxetine (Paxil) is the selective serotonin reuptake inhibitor (SSRI) most likely to lead to extra pounds. SSRIs are the most commonly prescribed type of antidepressants. Other types that may lead to extra pounds are tricyclic antidepressants (such as amitriptyline) and monoamine oxidase inhibitors, which include phenelzine (Nardil).

Lupus Symptoms

Some symptoms of lupus can cause weight gain. For example, lupus nephritis, a type of kidney disease, affects about 50 percent of people with lupus. When the kidneys aren’t working properly, fluid can build up and increase body weight.

Most people with lupus also have muscle or joint pain and severe fatigue. These symptoms can make it hard to be physically active, which can lead to weight gain.

The impacts of lupus on the heart and blood vessels can also affect weight. Atherosclerosis, or blocked blood vessels, is the most common type of heart disease in people with lupus. The blockages can lead to heart attacks and eventually cause cardiomyopathy — a chronic illness that lowers the heart’s ability to pump blood.

Cardiomyopathy can cause fluid buildup in the arms and legs, as well as fatigue and difficulty breathing. These heart problems can make it challenging to stay active. Thankfully, cardiomyopathy is a rare complication of lupus.

Taking Care of Yourself

Having a higher body weight may simply be a part of managing your condition. Medications associated with weight gain may be necessary to control your symptoms and improve your quality of life. However, if you feel uncomfortable at your current weight, you can take steps to feel better. Being as active as your condition allows and eating well may affect your weight in a positive way, plus offer benefits that are unrelated to the scale.

Exercise as You’re Able

If you’re living with lupus, being as active as possible has plenty of upsides. Besides helping you maintain your weight (if that’s a goal), exercise may help you feel better by:

• Improving the health of your heart, lungs, bones, and joints
• Lowering inflammation
• Boosting your mental health
• Reducing fatigue

Joint pain may make certain types of exercise difficult if you have lupus. Experts recommend low-impact activities that are easier on the joints, such as yoga, swimming, cycling, and walking.

Eat as Well as Possible

Following a balanced, nutritious diet may help improve lupus symptoms and other medical conditions you may have, like diabetes. A balanced diet includes:

• Fruits and vegetables (the more, the better)
• Whole grains, including wild rice and barley
• Low-fat protein, such as beans and some types of seafood and poultry
• Healthy fats, including olive oil and avocados

As always, check with your rheumatologist about exercise and diet before making big changes. They may recommend that you meet with a dietitian to help manage your lifestyle plan.

Find Your Team

On MyLupusTeam, the social network for people with lupus and their loved ones, more than 223,000 members come together to ask questions, give advice, and share their stories with others who can relate to their lupus experience.

Are you taking hydroxychloroquine and concerned about weight changes? Have you made any lifestyle changes to achieve or maintain a comfortable weight for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.