Use of SSZ in Rheumatoid Arthritis SSZ (Azulfidine) is often used in early and mild disease. Its potential for toxicity is low; it is often combined with other DMARDs. SSZ was designed as a two-component drug including sulfapyridine, which is antimicrobial, and 5-aminosalicylic acid (5-ASA), which is antiinflammatory. Dosage: 1 to 3 g/day in divided doses. …
What can interfere with antimalarial effectiveness? What drug interactions can occur? Smoking can induce hepatic cytochrome P450 enzymes resulting in accelerated metabolism of antimalarials, causing them to be less effective. Cimetidine can decrease the clearance of antimalarials. Antimalarials can increase digoxin levels and conversely antagonize the effects of anticonvulsants and amiodarone. Due to the effects …
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How common is antimalarial retinopathy and what steps can be used to decrease this toxicity? Chloroquine binds more avidly to corneal and retinal pigmented epithelium than HCQ and, thus, causes more corneal deposits and retinopathy. Corneal deposits are not an indication to stop antimalarials, but retinopathy is an absolute indication to stop therapy. The overall …
Use of antimalarial therapy in SLE Antimalarial therapy is very useful in treating patients with SLE. Skin manifestations, serositis, fatigue, and joint disease are especially responsive to treatment. Additionally, antimalarials are useful in maintaining remissions and preventing flares of disease. Pregnant lupus patients (anti-SS-A + ) on antimalarial therapy have been shown to be less likely to have a child with …
In which rheumatic conditions has treatment with antimalarials been effective? • RA. • Juvenile idiopathic arthritis (JIA). • SLE. • Discoid lupus, skin rash of dermatomyositis. • Antiphospholipid antibody syndrome. • Palindromic rheumatism. • Psoriatic arthritis (controversial)—use with caution or not at all, because antimalarials may exacerbate psoriatic skin lesions. • Sjögren’s syndrome (controversial). • Sarcoidosis. • Erosive osteoarthritis (controversial).
What is the mechanism of action of antimalarials? The precise MOA is unknown. Antimalarials are weak bases and accumulate in acidic vesicles such as lysosomes. By increasing lysosomal pH, there is a disruption in the normal assimilation of peptides with class II major histocompatibility complex molecules or binding of RNA/DNA to toll-like receptors (especially TLR7, …
How are antimalarials used in the treatment of rheumatic diseases such as RA or SLE? Antimalarials are the least toxic of all DMARDs and can be safely combined with other DMARDs. They are particularly effective in early treatment or add-on therapy of RA patients with mild to moderate disease manifestations. HCQ is the main antimalarial used. Dosage: HCQ …
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