The role of anti-malarials in rheumatoid arthritis--the American experience

Rheumatoid Arthritis (RA) is a chronic disease with significant morbidity and functional disability. The traditional treatment for RA relied on the use of NSAIDs early in the disease course, followed by disease-modifying agents later. More recently, the disease-modifying anti-rheumatic drugs (DMARDs) have become the mainstay of RA therapy because of the recognition of their superior efficacy/toxicity profile. The antimalarial drugs, chloroquine and hydroxychloroquine, are some of the most commonly used DMARDs in the management of RA. They have been shown to be significantly more effective than NSAIDs alone in several clinical trials, and have a benign toxicity profile. A combination of hydroxychloroquine with methotrexate appears to reduce significantly the hepatic toxicity of methotrexate. In this review, we summarize the efficacy and toxicity profiles of the antimalarial drugs in rheumatoid arthritis.