Originally developed to treat malaria, hydroxychloroquine (Plaquenil) has been used for many years to treat patients with mild rheumatoid arthritis that lack response to NSAIDs.  While the exact reason for how Plaquenil works is not fully understood, it appears to interfere with the immune system, relieving pain and inflammation in about 30 % of patients.  Since it has few side effects and does not require regular blood test monitoring, rheumatologists are willing to try it early in the course of mild rheumatoid arthritis (RA) and for patients with systemic lupus erythematous (SLE), especially those with skin and joint involvement.

Given orally, usually 200mg once or twice daily as a maintenance dose, Plaquenil takes three to six months to take effect.  Plaquenil can be taken in addition to NSAIDs or Methotrexate (MTX) to achieve synergistic effects to control severe rheumatoid arthritis and SLE with severe skin involvement.  Occasional side effects may include nausea, or mild abdominal discomfort, a small possibility of skin rash and dizziness, and a very rare instance of retinal damage.

Because of the concern over the possibility of retinal damage with the use of Plaquenil, the American Academy of Ophthalmology (AAO) issued a guideline in 2002 stating that the side effect appeared to be an exceptionally rare adverse event.  Following that statement, the AAO recommended that one screening for retinopathy should be performed between the ages of 20-29 years, with consecutive screenings every two to four years between the ages of 40-64 years old.  For high risk patients, such as those taking more than 6.5mg/kg of hydroxychloroquine, those using the drug more than five years, those who are obese, those with kidney or liver disease, and those patients over the age of 60, further monitoring was advised.

As a general rule, Plaquenil is very safe if you take it under the supervision of your physician.  A large number of my patients are taking Plaquenil with good results, but it is recommended for them to schedule yearly eye examinations, regardless of their risk.

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