History of Anti-Malarials
Anti-malarial medications, which are also anti-rheumatic drugs, are derived from the bark of the Peruvian cinchona tree. The active agents, quinine and cinchona, were isolated by Pelltier in 1820.
Anti-malarials were first used during World War II to treat parasitic infections like malaria. As early as the 1960s it was found that these medications could also be used to treat the joint pain that occurs with rheumatoid arthritis. Soon thereafter, anti-malarials were found to have similar beneficial effects in the treatment of joint pain associated with systemic lupus erythematosus (SLE). Some physicians also used it for the treatment of Sjogren's syndrome.
Use in the Treatment of Lupus
Anti-malarials are particularly effective in treating skin and joint symptoms that may occur in SLE. They have been demonstrated to improve:
- muscle and joint pain
- inflammation of the lining of the heart (pericarditis)
- inflammation of the lining of the lung (pleuritis)
- other symptoms of lupus such as fatigue and fever.
However, anti-malarials alone are not appropriate treatment for more severe manifestations of systemic lupus as kidney disease.
Anti-malarials are very effective in the treatment of discoid lupus erythematosus (DLE): 60-90 percent of those with DLE went into remission or showed major improvements after being treated with anti-malarials. Skin lesions of DLE which have not responded to treatment with topical therapy (e.g., creams, ointments) may improve with the use of anti-malarial drugs.
Anti-malarials are also useful in subacute cutaneous lupus, and in overlap syndromes which have acute symptoms of lupus and other autoimmune disorders.
Types of Anti-Malarials
The anti-malarials used in North America for the management of systemic lupus include:
- hydroxychloroquine (Plaquenil)
- chloroquine (Aralen)
- quinacrine (Atabrine).
These medications are not equivalent in their side effects. In the United States, hydroxychloroquine (Plaquenil) is the most popular because it is felt to be less likely to cause eye side effects. Quinacrine is only available from compounding pharmacists.