How treating malaria lead to the development of an arthritis medicine

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Hydroxychloroquine and chloroquine have been used to treat rheumatic diseases since the 1950’s.

Prior to that they had been used as effective remedies for malaria. The mechanism of action is unknown but there appear to be immunomodulatory effects on T cells. Hydroxychloroquine is used much more often than chloroquine because of less eye toxicity.

Hydroxychloroquine is given orally in a dose of 5 to 6 mgs per kilogram body weight. It is absorbed well and should be taken with food.

Indications include mild rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, palindromic rheumatism, inflammatory arthritis, and undifferentiated connective tissue disease.

In lupus, hydroxychloroquine is effective for skin and joint symptoms. It is not effective for other systemic problems.

Antimalarials are in the disease modifying antirheumatic drug (DMARD) class. That means they help with inflammation and swelling and prevent joint destruction. DMARDS act slowly.

It takes roughly three to six months before a beneficial effect is seen. Antimalarials have been shown to be effective for the joint symptoms in rheumatoid arthritis.

They are often combined with methotrexate abnd/or sulfasalazine to achieve an additive effect on diseases associated with the former drug. This use of combination therapy is less common now with the advent of biologic therapy.

Side effects include gastrointestinal upset, rash, headache, blurred vision due to a rare effect on one of the small muscles in the eye, discoloration of the skin, myopathy (weakness of muscles), abnormal effects on blood, hearing problems, breakage of red blood cells in patients who have G6PD deficiency, and retinal toxicity. Retinal toxicity is rare. Eye exams are recommended at least every six months. Patients may also monitor themselves more frequently using an Amsler grid, a special card available from most opthalmologists. There has beren some data suggesting that the usual monitoring is not good enough and special tests are needed.

When retinal toxicity does occur, it happens slowly, after many years of accumulation, and is irreversible. Risks of retinal toxicity increase with advancing age, impairment of kidney or liver function, and cumulative dose above 700 grams.

Antimalarials should not be used by women who are pregnant or those women who are nursing. Antimalarial drugs can be toxic to nursing infants.

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