One key thing that characterises CLIPPERS is that it responds to steroids in the first instance. So characteristic is this that "Responds to Steroids" is the "RS" in CLIPPERS. Everyone who is treated for CLIPPERS, at some point or another, receives steroid treatment, which for many patients means high-doses of intra-venous Prednisolone.
A recent case study (but only a single case) hints that other treatment paths may be possible. I must stress that a single case in a condition that is hard to diagnose like CLIPPERS can't be definitive, but this is interesting none-the-less.
This patient had diagnoses first of Multiple Sclerosis and subsequently of neurosarcardosis (both conditions that were considered in my case also). Treatment was with hydroxychloroquine which is an anti-inflammatory used in the treatment of neurosarcoidosis. (Interestingly, the FAQ here, suggests that Prednisolone is the drug of choice for neurosarcoidosis, showing once again that there are many overlapping conditions which can be treated somewhat similarly.) The patient had good resolution of symptoms however, after their symptoms, tests and records were re-examined, the diagnosis was changed to CLIPPERS; the patient has remained well on maintenance doses of hydroxychloroquine since. Also interestingly, Dr Pittock at the Mayo Clinic, had previously tried hydroxychloroquine in one CLIPPERS patient but did not have as good results as in this case study.
The authors suggest hydroxychloroquine be considered as an alternative treatment for CLIPPERS because it is well-tolerated by patients, although it is not without side-effects. It will be interesting to see if this study affects treatment decisions in any future patients and whether the good results gained here can be reproduced.
Read other articles in this series at Living With CLIPPERS.
Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
