Antimalarial medications for juvenile rheumatoid arthritis

Examples

Generic Name	Brand Name
hydroxychloroquine sulfate	Plaquenil

How It Works

Antimalarial medications (normally used to prevent and treat malaria) are sometimes used in an attempt to reduce inflammation associated with juvenile rheumatoid arthritis (JRA).

Why It Is Used

Antimalarial medications may be used along with nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis that has not responded to NSAIDs alone. This combination is more commonly used to treat progressive polyarticular arthritis but can be used for any form of JRA.

How Well It Works

Although some people get better with antimalarials, a large study of the effects of antimalarial treatment for JRA showed them to be no better than a placebo.¹ It may take up to 16 weeks to see an effect from hydroxychloroquine. The medicine is usually discontinued if no improvement is seen after 16 weeks.

Side Effects

Hydroxychloroquine may cause damage to the retina of the eye. But this effect is very rare when hydroxychloroquine is given at appropriate doses. It is recommended that your child have an eye examination with an ophthalmologist prior to taking the medicine and every 6 to 12 months while taking it. In addition, some doctors recommend that you continue to check your child's vision at least once a month using an Amsler grid, which is a chart with lines and a dot at the center that lets you monitor changes in vision. If you or your child notice any changes in vision or changes in his or her view of the Amsler grid , contact your child's doctor immediately. Assuming your child has no changes in vision, the frequency of ophthalmologist visits may vary depending on whether your child has or is at high risk of developing eye disease from JRA.

Hydroxychloroquine may also cause skin rash, stomach and intestinal upset, sensitivity to light, and blood in the urine (hematuria). In rare cases, hydroxychloroquine may cause muscle weakness.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

It is recommended that children have a complete eye examination before the start of antimalarial medication therapy. Hydroxychloroquine has a potentially serious side effect: damage to the retina of the eye. When appropriate doses are given, this effect is rare. If it is detected early, permanent damage may be prevented. So, your child should have an initial ophthalmic examination before beginning hydroxychloroquine therapy and subsequent examinations if and when you or your child notices a change in vision. Your doctor may recommend visits to the ophthalmologist as frequently as every 6 to 12 months or as infrequently as every 5 years, depending on your child's vision and your doctor's level of concern about eye disease from JRA.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: June 25, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Stanford M. Shoor, MD - Rheumatology
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