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Antimalarials and Lupus


Antimalarials are very effective in controlling lupus arthritis, skin rashes, mouth ulcers, and other symptoms such as fatigue and fever. They are used to manage less serious forms of systemic lupus erythematosus (SLE) in which no organs have been damaged. Antimalarials are not used to manage more serious, systemic forms of SLE that affect the organs.

This group of drugs was first developed during World War II because quinine, the standard treatment for malaria, was in short supply. Investigators discovered antimalarials could also be used to treat the joint pain that occurs with rheumatoid arthritis. Subsequent use of antimalarials showed that they are effective in controlling lupus arthritis, skin rashes, mouth ulcers, fatigue, and fever. Antimalarials are also very effective in the treatment of discoid lupus erythematosus (DLE).

Although antimalarials may be very effective in controlling your lupus, their use takes patience. It may take weeks or months before you see any change in symptoms from the use of these drugs.

Possible Side Effects

These include stomach upset, loss of appetite, vomiting, diarrhea, blurred vision, difficulty in focusing, headache, nervousness, irritability, dizziness, muscle weakness, dry and itchy skin, mild hair loss, rash, change in skin color, and unusual bleeding or bruising.

Types of Antimalarials

The drugs most often prescribed are hydroxychloroquine sulfate (Plaquenil®) and chloroquine (Aralen®).

Mechanism of Action and Use

The anti-inflammatory action of these drugs is not well understood. In some patients who take antimalarials, the total daily dose of corticosteroids can be reduced. Antimalarials also affect platelets to reduce the risk of blood clots and lower plasma lipid levels.

Potential Side Effects

  • Central Nervous System: headache, nervousness, irritability, dizziness, muscle weakness, and tinnitus
  • Gastrointestinal: nausea, vomiting, diarrhea, abdominal cramps, and loss of appetite
  • Ophthalmologic: Visual disturbances and retinal changes are manifested by blurring of vision and difficulty in focusing. A very serious potential side effect of antimalarial drugs is damage to the retina. Because of the relatively low doses used to treat SLE, the risk of retinal damage is quite small: about 1 in 5,000. However, patients should have a thorough eye examination before starting this treatment and yearly thereafter.
  • Dermatologic: dryness, pruritus, alopecia, skin and mucosal pigmentation, skin eruptions, and exfoliative dermatitis
  • Hematologic: blood dyscrasia and hemolysis in patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency

Precautions

  • There is a small chance that antimalarials will harm a fetus. If you are considering pregnancy, your doctor may take you off the drug.
  • Do not take more than the recommended dose.
  • Do not take this drug with other drugs, including over-the-counter medications, without first checking with your nurse or doctor. Over-the-counter medications are medications that you can buy without a doctor’s prescription.
  • Tell any nurse, doctor, or dentist who is taking care of you that you are taking an antimalarial for your lupus.
  • WARNING! A possible, serious side effect of antimalarials is damage to the retina of the eye. Although this is rare with the low doses of drug that are prescribed, it is extremely important that you have a thorough eye examination before starting treatment with this drug, and every 12 months after that.
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