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PubMedDate not supplied

Hydroxychloroquine in psoriatic arthropathy: exacerbations of psoriatic skin lesions.

Antimalarial therapy in psoriatic arthritis was felt to be contraindicated traditionally due to frequent exacerbation of psoriatic skin disease. Interest in hydroxychloroquine treatment of psoriatic arthritis has been revived because of recent series found no exacerbation of psoriatic skin lesions in 50 psoriatic arthropathy patients treated with hydroxychloroquine. A psoriatic arthropathy patient whose skin lesions were markedly exacerbated by hydroxychloroquine is reported. The literature on antimalarial effects on psoriatic skin lesions is briefly discussed.

Adult↗
PubMed1980

Hydroxychloroquine treatment of porphyria cutanea tarda.

Six patients with skin changes and urinary porphyrin excretion patterns characteristic for porphyria cutanea tarda were treated with hydroxychloroquine sulfate therapy. During treatment periods ranging from five to 13 months, cutaneous symptoms disappeared and urinary porphyrin excretion abnormalities were completely or almost completely reversed. In three subjects, hydroxychloroquine therapy was accompanied by changes in the urinary excretion of iron. The first four patients, followed up for nine to 24 months after treatment, all had relapse, and substantial porphyrinuria developed once more; cutaneous symptoms recurred in two of these. Three of the four patients were re-treated, and their conditions again improved or went into remission with hydroxychloroquine therapy. In two patients, treatment responses were slower than those initially seen, despite the use of higher drug doses; in the third patient, the response to re-treatment was more rapid than that seen during the first treatment course.

Adult↗
PubMed1976

Prevention of venous thromboembolism by administration of hydroxychloroquine. A preliminary report.

A placebo or the antimalarial agent hydroxychloroquine (Plaquenil), which inhibits platelet adhesiveness, and, to a lesser extent, platelet aggregation, was given to 100 patients between forty and ninety-five years old (average age, seventy-four years) who had either fractures or orthopaedic operations involving the skeleton between the knee and the pelvis. Medication was started at the time of admission in a blind, randomized way, fifty patients receiving hydroxychloroquine (200 milligrams three times a day) and fifty, a placebo. No untoward bleeding complications were noted in the treated group. Eight instances of thromboembolism were encountered in the control group as compared with one in the hydroxychloroquine-treated group, a statistically significant difference at the 1.5 per cent level.

Adult↗
PubMed1994

Current practices for monitoring ocular toxicity related to hydroxychloroquine (Plaquenil) therapy.

OBJECTIVE: Growing interest in aggressive early management of rheumatoid arthritis (RA) with hydroxychloroquine (alone or in combination with other immunomodulating drugs) is reason to review current practices for monitoring ocular toxicity in patients who take antimalarial therapy. METHODS: We surveyed by mail all ophthalmologists and rheumatologists in the State of Indiana about their practices in this regard. RESULTS: Twenty-nine of 31 rheumatologists (94%) responded. All but one recommended ophthalmologic examinations every 6 months and 41% would leave the choice of testing procedures to the ophthalmologist. Fifty percent had discontinued hydroxychloroquine because of a patient's failure to make and/or keep an appointment with the ophthalmologist. Of 213 ophthalmologists surveyed, 150 (70%) responded. Seventy-nine percent recommended semiannual examinations. Funduscopy, visual acuity, and color vision tests were reported to be performed routinely. Eleven of 13 retina specialists (85%), but only 25% of 127 general ophthalmologists, would obtain macular photographs (p < 0.001). Forty-two percent of general ophthalmologists, compared with 8% of retina specialists, would perform computerized perimetry (p < 0.001). Recognition of retinal hyperpigmentation as a classic sign was surprisingly low in both groups. Concurrent review of the medical records of 24 patients with RA or systemic lupus erythematosus showed extremely variable followup intervals for ophthalmologic examination; 7 of the 24 patients had no record of an ophthalmologic evaluation. CONCLUSION: As interest in the early, aggressive management of RA continues to grow, significant education needs to be devoted to the monitoring and diagnosis of ocular toxicity of hydroxychloroquine by both rheumatologists and ophthalmologists.

Adult↗
PubMed1993

Hydroxychloroquine toxicity despite normal dose therapy.

The risk of retinopathy associated with the use of hydroxychloroquine is said to be nullified if the dosage recommendations are followed strictly. In this case report, we describe an elderly patient with rheumatoid arthritis who had bilateral maculopathy, presumably secondary to hydroxychloroquine therapy, despite a dosing regimen within therapeutic guidelines. We believe special attention should be given to elderly patients who are being treated with hydroxychloroquine because their retinal pigment epithelium may be more susceptible to the toxic effects of this drug.

Aged↗
PubMed1993

Selective regulation of cytokine secretion by hydroxychloroquine: inhibition of interleukin 1 alpha (IL-1-alpha) and IL-6 in human monocytes and T cells.

To study the effect of hydroxychloroquine on cytokine production by monocytes and T cells, cells were pretreated with varying concentrations of hydroxychloroquine and stimulated with lipopolysaccharide (monocytes), phytohemagglutinin or anti-CD-3 monoclonal antibodies (T cells). Interleukin 1 alpha (IL-1-alpha), IL-6 and tumor necrosis factor alpha (TNF-alpha) production were measured from the stimulated monocytes and IL-2, IL-4 and gamma interferon (IFN-gamma) were measured from the stimulated T cells. Hydroxychloroquine inhibited production of IL-1-alpha (monocytes) and IL-6 (T cells and monocytes). In contrast IL-2, IL-4, TNF-alpha and IFN-gamma production were not affected. Preferential inhibition of IL-1-alpha production by monocytes and IL-6 production by T cells and monocytes may contribute to its antiinflammatory effect in autoimmune diseases.

Cytokines↗
PubMed1993

Insights from pharmacokinetic and pharmacodynamic studies of hydroxychloroquine.

There is wide variability between subjects in the pharmacokinetic parameters of hydroxychloroquine. A range of concentrations is achieved by individuals receiving the same dosage. In a cross-sectional study, mean hydroxychloroquine concentrations in patients with shorter duration and lower intensity of morning stiffness and no rheumatoid factor were significantly higher than in patients with worse disease activity. Variable kinetic parameters, causing variable concentrations, are likely to be contributing to the variability in response to hydroxychloroquine in rheumatic diseases.

Adult↗
PubMed1993

Combination therapy in rheumatoid arthritis--no benefit of addition of hydroxychloroquine to patients with a suboptimal response to intramuscular gold therapy.

OBJECTIVE: To determine if there is any advantage in adding hydroxychloroquine to intramuscular gold therapy in patients with rheumatoid arthritis (RA) with a suboptimal response to gold after 6 months of treatment. METHODS: Prospective double blind placebo controlled study at the Centre for Rheumatic Diseases, Glasgow Royal Infirmary and Gartnavel General Hospital, Glasgow. Patients--440 patients with RA began intramuscular gold therapy. One hundred forty-two patients with a suboptimal response at 6 months were randomized to receive additional treatment with hydroxychloroquine (400 mg/day) or placebo, and followed for a further 6 months. Outcome measures were erythrocyte sedimentation rate, C-reactive protein, Ritchie articular index, grip strength, visual analog pain score, duration of morning stiffness, health assessment questionnaire, and rate of side effects. RESULTS: There was no difference in outcome in terms of efficacy or toxicity. CONCLUSION: There is no justification for using a combination of intramuscular gold and hydroxychloroquine in patients with RA with a partial response to gold.

Arthritis, Rheumatoid↗
PubMed1996

Hydroxychloroquine use in the Baltimore Lupus Cohort: effects on lipids, glucose and thrombosis.

Hydroxychloroquine is used by 35% of SLE patients enrolled in the Baltimore Lupus Cohort. Eighty per cent of patients who took hydroxychloroquine at cohort entry remain on it six years later. In addition to its role for disease manifestations of lupus, hydroxychloroquine may be indicated for the prevention of disease or treatment-induced complications, including hyperlipidemia, diabetes mellitus, liver function test elevation and thrombosis.

Antirheumatic Agents↗
PubMedDate not supplied

Ototoxicity due to hydroxychloroquine: report of two cases.

We report two cases of irreversible sensineuronal hearing loss due to hydroxychloroquine treatment. The first patient was a 44-year-old woman with long-standing systemic lupus erythematosus and the second case was a 44-year-old man with clinical manifestations consistent with subacute cutaneous lupus erythematosus. They both developed irreversible hearing loss after several years of hydroxychloroquine treatment. Sensineuronal deafness has previously been reported in connection with chloroquine treatment, but this is the first report of ototoxicity associated with hydroxychloroquine.

Adult↗
PubMed1984

Controlled trial of hydroxychloroquine and D-penicillamine singly and in combination in the treatment of rheumatoid arthritis.

A 2-year, controlled, double-blind trial of D-penicillamine and hydroxychloroquine either alone or in combination was conducted on patients with progressive rheumatoid arthritis. The group given D-penicillamine alone improved most, but a linear fall-off in efficacy occurred. Surprisingly, the group receiving combination drug therapy did not fare as well as the group receiving D-penicillamine therapy. A subset of patients receiving hydroxychloroquine therapy had prolonged benefit. Toxicity, though not uncommon, was generally not severe.

Adult↗
PubMed1990

Aspirin, hydroxychloroquine, and hepatic enzyme abnormalities with methotrexate in rheumatoid arthritis.

Levels of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) in patients with rheumatoid arthritis from 5 centers involved in the Arthritis, Rheumatism, and Aging Medical Information System were correlated with the use of specific antirheumatic medications. Elevated levels of SGOT and SGPT were most frequent in patients taking salicylates and methotrexate (MTX) and least frequent in patients taking hydroxychloroquine. The combination of MTX and salicylates greatly increased the frequency of abnormal liver enzyme values. In contrast, the addition of hydroxychloroquine to a regimen of either MTX or aspirin essentially eliminated the SGOT and SGPT abnormalities. Results from all 5 centers were consistent and remained so after adjustment for age, sex, and disease duration. Knowledge of these important drug interactions may permit continuation of MTX therapy in patients in whom the drug might otherwise be discontinued.

Alanine Transaminase↗
PubMed1988

How reliable is ESR as a measure of disease activity in rheumatoid arthritis treated with hydroxychloroquine?

Forty-two patients with active rheumatoid arthritis treated with hydroxychloroquine sulphate (400 mg day-1) for six months have been compared with patients treated with D-penicillamine (n = 14), aurothiomalate (n = 13), sulphasalazine (n = 15) and chloroquine (n = 17) to compare the changes in articular index, plasma viscosity and ESR. Results indicate that while articular index and plasma viscosity show significant improvement for all treatments, the ESR fails to improve during hydroxychloroquine therapy.

Arthritis, Rheumatoid↗
PubMed2000

Hydroxychloroquine-induced seizure in a patient with systemic lupus erythematosus.

We report on a case of a 17-year-old female with systemic lupus erythematosus (SLE), with a clinical history of complex partial seizure, who developed a tonicoclonic crisis after receiving hydroxychloroquine for 2 weeks at a dosage of 200 mg/day (5 mg/kg). The absence of previous similar episodes and of recurrences after withdrawal of the drug in subsequent months, the short latency after administration and the favourable short-term evolution raised suspicions for a potential role of the drug in the development of the isolated convulsive crisis. It is possible for hydroxychloroquine to be responsible for tonicoclonic seizures in predisposed subjects.

Adolescent↗
PubMed1983

Hydroxychloroquine in the treatment of rheumatoid arthritis.

One hundred eight patients with rheumatoid arthritis received hydroxychloroquine for six to 24 months and were studied retrospectively to examine long-term efficacy and predictors of a favorable response to the drug. Response was classified in terms of reduction of active joint count and morning stiffness. Thirteen patients (12 percent) showed a complete remission. Fifteen patients (14 percent) had a 75 percent or greater response. Forty patients (37 percent) had a 30 to 75 percent response. Thirty-two (30 percent) had no response. Toxicity occurred in eight patients (7 percent) before clinical efficacy could be assessed. Seven of the 68 with response had a flare of disease after initial improvement. Of multiple clinical and laboratory parameters tested, only a stronger baseline grip strength was found to be statistically significant (p less than 0.001) in predicting a favorable response. Thus, hydroxychloroquine is an effective drug in the management of rheumatoid arthritis.

Adult↗
PubMed1987

Hydroxychloroquine therapy in massive total doses without retinal toxicity.

To assess the relationship between hydroxychloroquine retinal toxicity and total dose, we selectively reviewed the histories of patients who had received an additive dose exceeding 1,000 g. No retinopathy was found in nine patients treated with massive total hydroxychloroquine doses ranging from 1,054 to 3,923 g. Eight of these patients were taking recommended daily doses of 400 mg/day or less and showed no evidence of toxicity. The remaining patient treated with 600 mg/day showed evidence of preretinopathy in one eye.

Adult↗
PubMed1990

Hydroxychloroquine is effective therapy for control of cutaneous sarcoidal granulomas.

Cutaneous sarcoidosis often responds poorly to topical and intralesional corticosteroids but may respond to moderate to high doses of oral corticosteroids. To avoid the use of systemic corticosteroids, we treated 17 patients with cutaneous sarcoidal granulomas with hydroxychloroquine (2 to 3 mg/kg/day) in an open clinical trial. If response occurred, other medications were first tapered and then the hydroxychloroquine dosage was reduced or stopped. The cutaneous lesions of 12 patients regressed within 4 to 12 weeks, and they were able to stop other therapies; three patients had a partial response, and two patients had no regression. Two of eight patients with pulmonary sarcoidosis improved. No ocular toxicity was noted.

Adult↗
PubMed2005

Hydroxychloroquine-induced cardiotoxicity in a 39-year-old woman with systemic lupus erythematosus and systolic dysfunction.

A 39-year-old woman with a history of systemic lupus erythematosus developed chest pain and conduction abnormalities. An echocardiographic examination revealed systolic dysfunction and ventricular thickening. Because of the unclear nature of her cardiac disease, right ventricular endomyocardial biopsy was performed. Light microscopy showed diffuse myocyte vacuolization without myocarditis, and transmission electron microscopy demonstrated sarcoplasmic myelinoid and curvilinear bodies, diagnostic of hydroxychloroquine toxicity. Among patients with autoimmune connective disorders, cardiac dysfunction may be a result of the disease or occasionally of its treatment. Although the nature of the cardiac disease (myocardial, valvular, or pericardial) can generally be evaluated echocardiographically, endomyocardial biopsy may be indicated to rule out diseases with a specific microscopic appearance, such as myocarditis or hydroxychloroquine cardiotoxicity.

Cardiomyopathies↗