National Arthritis Foundation

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Anti-malarials and Arthritis

Corticosteroids

Diet Advice for the patient with Gout

Exercise and Arthritis

Food and Arthritis

Immunosuppressive Drugs

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Arthritis

Arthritis or inflammation of a joint (manifesting as joint pain and swelling) can be due to many causes. One of the causes is Rheumatoid Arthritis, an inflammatory condition that affects both the large and small joints. Untreated arthritis can result in permanent joint damage. The aim of early treatment is to prevent or retard progression of the disease. Pain and inflammation may be controlled initially by a group of drugs called the non-steroidal anti-inflammatory drugs. However many patients need a second group of drugs called disease-modifying anti-rheumatic drugs (also termed slow-acting anti-rheumatic drugs). Anti-malarials are one of the drugs in this group.

Anti-malarials

Chloroquine and Hydroxychloroquine are 2 examples of anti-malarial drugs. These drugs were initially used in the treatment of malaria. Later they were also found to be useful in the treatment of arthritis, particularly rheumatoid arthritis. They can also be used to treat systemic lupus erythematosus patients, especially those who have skin or joint involvements, Anti-malarials should not be used in psoriatic arthritis as they can exacerbate flares of psoriasis.

Things to Remember When You are on Anti-malarials

Both Chloroquine and Hydroxychloroquine tablets are usually taken once-a-day according to the doctor's instruction.
You should continue to take other medications prescribed by the same doctor. If in doubt always ask your doctor.
You will need to have your eyes examined by an ophthalmologist at the start of treatment and as often as your doctor recommends. On the average, a six to nine monthly examination is carried out.
If you are pregnant while on anti-malarials, you have to inform your doctor immediately.
Chloroquine or Hydroxychloroquine may take up to four months to be fully effective and you will need to be patient and stay on the treatment for this period.
Any unusual reaction or side effect should be reported to your doctor as soon as possible.

What are the Possible Side-effects?

Side effects can occur with any drug and anti-malarials are no exception. When taken according to the doctor's instruction, they are infrequent. The following may occur:

skin rashes or pigmentation
nausea, stomach upset
muscle weakness (rare)
nervousness, headache, dizziness
transient blurring or vision - this usually resolves in 1 to 2 weeks
permanent damage to the retina (cell layer at the back of the eye). Affected patients may notice blurring around lights or have to look to one side of an object in order to see it clearly. This risk is very greatly reduced by regular eye examination and following the doctor's instruction on daily dosage. Hydroxychloroquine has a lower risk compared to chloroquine.