Anti-malarials were first derived from the bark of cinchona tree in 1820 & have been in use for arthritis since 1960.
They include—
1) Chloroquine (Aralen)
2) Hydroxychloroquine (Plaquenil)
3) Quinacrine.
Amongst these, hydroxychloroquine is the most commonly used medication for Rheumatoid Arthritis, SLE. It acts by reducing the activation of dendritic cells (one of the immune cells) & thereby reduces the joint inflammation. It has proven efficacy in controlling the joint inflammation of RA. Thus, Hydroxychloroquine is not a painkiller but a DMARD (Disease modifying ant-rheumatic drug- an actual anti-arthritis drug).
As seen previously, we have more than 50 years experience of the drug & it is one of the safest DMARD. It is not the most potent of the lot & is always combined with other DMARDs to boost their effectiveness.
Hydroxychloroquine is a well-tolerated medication & serious side effects are rare. The most common side effect is its bitter taste. The bitter aftertaste can cause nausea in some. Taking the tablet along with food, rather than after food, can take care of this problem. It can also cause acidity & the same generally settles with proper diet & routine antacid medications.
It tends to affect the skin pigmentation in a few individuals. Over pigmentation (darkening of the skin) can occur & should be brought to notice of your Rheumatologist. You can reduce the chances of over-pigmentation by wearing a full-sleeve dress/ a sunscreen & using an umbrella when in the sun.
More serious side effect includes retinopathy (manifests as visual changes or loss of vision). Medical literature emphasizes that over 1,000,000 patients have used either Chloroquine or Hydroxychloroquine, while only 20 cases of retinal toxicity have occurred in individuals using appropriate doses. In addition, all of these reported patients with retinal toxicity were using the drugs for more than 5 years. The incidence of retinal toxicity with Hydroxychloroquine treatment is estimated to be about 1 in 50,000 patients & is thus extremely rare. The same can be prevented by regular eye examination & self use of amsler grid. You can download the Amsler grid here.
Apart from the anti-arthritis properties it also has additional benefits-
1) Reduces the blood glucose & helps diabetics
2) Improves serum lipids
All in all, hydroxychloroquine is a safe DMARD. Though it is not the most potent but definitely helps other DMARDs put RA in remission.
Arthritis support board 
Yesterday only checked eyes of my wife. She is now on Hydroxychloroquine for more than 7 months. As per the eye specialist’s report; the condition of eyes is normal including vision, colour etc. Thus no side effects of Hydroxychloroquine are observed. I am happy !!
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[…] This post was mentioned on Twitter by Dr. shashank akerkar, Dr. shashank akerkar. Dr. shashank akerkar said: Are allopathic anti-arthritis drugs really toxic?- anti Malarials (Plaquenil) http://wp.me/pEF1Q-1W […]
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my eyes are also fine…..
earlier bitterness use to bother a little…..bt nw not even that…
i dnt get the taste of it anymore ….
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Thanks for the following clarification. I’d been half poking around trying to find out how they think how plaquenil works for/in RA.
“It acts by reducing the activation of dendritic cells (one of the immune cells) & thereby reduces the joint inflammation. It has proven efficacy in controlling the joint inflammation of RA. Thus, Hydroxychloroquine is not a painkiller but a DMARD (Disease modifying ant-rheumatic drug- an actual anti-arthritis drug).”
I had read about the eye problem reports happening after 5 to 7 years and am wondering if I should stop it after I’ve taken it that long. I’ve been on it less than a year, but it sure does seem to help the pain, and yes, with fatigue too, that methotrexate hadn’t adequately helped all these years. I do notice more pain if I miss a dose and so it makes me NOT want to ever have to go off of this drug! Maybe by then they will find something else. My rheumatologist did explain that it works synergistically with methotrexate and can continue to see more improvements up to 6 (to 9?) months or so after starting the plaquenil. I’m not perfect and still have some significant pain, and some persistent swelling, but it has made a difference in how I feel. I don’t know if it will help slow the damage down more, but wish we’d started it earlier.
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Yes, Chelsea;
Plaquenil is a very good medication for RA. Though it is not very potent by itself, it does augment the effect of methotrexate.
As you have seen, the incidence of the eye problem is very low (1 in 50,000). You dont have to stop taking Plaquenil just for this fear; especially since it is helping you so much. Do keep an Amsler grid with you & use it on a regular basis.
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Also, it has allowed me to cut my prednisone down to 3 mgs, which has helped me lose some weight and my “moon face”, but I still have the buffalo hump and stretch marks from the prednisone. It still will be hard to wean off of prednisone completely, even at, and especially at this low dose. I will wait until winter is over and use a pill cutter to cut my 1 MG prednisone pills at least in half and taper by that amount very slowly when spring and summer come. Perhaps I’ll be off by fall. I’ve been on prednisone for at least 12 years, but my highest dose was only 20 mgs, and most of the time was at 7.5 to 10 mgs.
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I am often to blogging and i really admire your content. The article has really peaks my interest. I’m going to bookmark your site and keep checking for new information.
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I’m having one of the lesser seen side effects of my hydroxychloroquine – tinnitus. I’m going to an ENT appointment in the next week or so, and will let you know what he says.
Cheerio!
Turtlemom
AKA Elizabeth
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