Antimalarials – are they effective and safe in rheumatic disease? Focus on the neuropsychiatric side effects

Neuropsychiatric manifestations are uncommon adverse events in patients with rheumatic diseases, when treated with chloroquine (CQ) or hydroxychloroquine (HCQ). This possibility is related to their ability to cross the blood-brain barrier ; in the brain, they have a tissue concentration up to10-20 times higher than the plasmatic one. A great variety of neuropsychiatric side effects was referred to CQ/HCQ; in some cases, they caused the patient' s hospitalization or death. Personal previous psychiatric symptoms, family history, female gender, alcohol intake, co-exposure with some drugs ( including low doses of glucocorticoids) , a dose >6.5 for HCQ and >3 mg/kg/day for CQ, are the most important risk factors. No difference between older and younger patients was found but polypharmacology and age-related renal impairment, can increase the risk in older ones. Differential diagnosis between pharmacological side effects and neuropsychiatric manifestations of the rheumatic disease is mandatory.

REFERENCES (11)

Haładyj E, Sikora M, Felis-Giemza A, Olesińska M. Antimalarials – are they effective and safe in rheumatic diseases? Reumatologia 2018; 56: 164-173.

Google Scholar

Rynes RI. Antimalarials. In: Textbook of rheumatology, Kelley WN, Harris ED Jr, Ruddy S, Sledge CB (eds.). Saunders Company, Philadelphia 2001: 864-865.

Google Scholar

Mascolo AM, Berrino PM, Gareri P, et al. Neuropsychiatric clinical manifestations in elderly patients treated with hydroxychloroquine: a review article. Inflammopharmacology 2018.

Google Scholar

doi: 10.1007/s10787-018-0498-5 [Epub ahead of print].

CrossRef

Google Scholar

Joaquim AF, Appenzeller S. Neuropsychiatric manifestations in rheumatoid arthritis. Autoimmun Rev 2015; 14: 1116-1122.

Google Scholar

Eaton WW, Byrne M, Ewald H, et al. Association of schizophrenia and autoimmune diseases: linkage of Danish national.

Google Scholar

registers. Am J Psychiatry 2006; 163: 521-528.

Google Scholar

Perzynska-Mazan J, Maslinska M, Gasik R. Neurological manifestations of primary Sjogren’s syndrome. Reumatologia 2018; 56: 99-105.

Google Scholar

Manzo C, Capuano A, Gareri P, et al. Manifestazioni neuropsichiatriche nel’anziano in corso di terapia con idrossiclorochina. Psicogeriatria 2017; 2: 77-81.

Google Scholar

10.

Manzo C, Gareri P, Castagna A. Psychomotor Agitation Following Treatment with Hydroxychloroquine. Drug Saf Case Rep 2017; 4: 6.

Google Scholar

11.

Altintas E. Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report. Düşünen Adam J Psychiatry Neurol Sci 2015; 28: 369-373.

Google Scholar

Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

Submit your paper

eISSN:	2084-9834
ISSN:	0034-6233