Antimalarials and Lupus

Hydroxychloroquine …created for malaria, but also benefits those with lupus

One of the first drugs that I was put on when I was being diagnosed with SLE was hydroxychloroquine. This is an anti-malarial medication, in its inception, but is widely used today for treating lupus symptoms.

How does this work?
Looking at malaria first helps us get an idea of how hydroxychloroquine works. Malaria is caused by a parasite that infects humans after being bitten by a mosquito whose saliva contains the parasite. The parasite crawls inside the person’s red blood cells.  Malaria breaks down part of the red blood cell (hemoglobin), and in this process produces toxic waste, which the parasite turns into a crystal to keep it from harming the parasite itself.  Chloroquine stops that crystal process from happening, binds to the toxic product and breaks up the malaria invader.1

CB065581Antimalarials work for people with lupus because they decrease the acid levels inside of lysosomes. Lysosomes are a small component of our cells that digest pieces of the cell’s functions. (Just like the malaria is doing inside the cell). In order for lysosomes to work at their highest level they need a certain acidity inside the cell. The chloroquine disrupts that and slows down the process, which for someone with an overactive immune system this is what you want to control the disease and symptoms. This drug inhibits the cell’s ability to take in and process Thiamine – which is a component of DNA that needs calming in lupus. The drug hydroxychloroquine is a break-down of the parent drug chloroquine and is most commonly used with lupus.1

Hydroxychloroquine has been found to interfere with internal communications of immune cells, by disrupting the danger signals giving off by the cell in the system. It’s a balancing act that needs to be done to protect the body from auto-immunity, and keeping the system in check to fight proper threats such as viruses. It is one of the weaker drugs that inhibits this type of activity.

Are there any other benefits to this drug in lupus treatment?
New studies have been showing that early use after diagnosis, of hydroxychloroquine, may have protective effects on the organs of those with SLE. They may be less likely to develop organ involvement and failure throughout the course of the disease. The studies show at three years after diagnosis, and use of hydroxychloroquine there was less cumulative organ damage by those prescribed hydroxychlorquine. 2

Another recent study found that short-term use of hydroxychloroquine can reduce the LDL cholesterol (therefore overall cholesterol) after three months of use. 3 This is good news, since there is an elevated risk of heart disease among lupus patients.

In the here and now, lupus patients are treated with hydroxychloroquine to help combat disease flares, overall disease damage over time, it delays absorption of UV light, and reduces the number of antigen presenting cells in the skin. There is also strong evidence supporting increased life span of those with SLE who use it, decreased lupus activity during pregnancy.4 It has even been shown in combination with other therapies to decrease pregnancy complications, such as pre-eclampsia and pregnancy loss due to SLE.5

Most people using this today use it to deal with fatigue, joint pain, mouth sores, hair loss and skin inflammation. 5

Side Effects
Pill Bottles Containing MedicationOf course there are side effects with anything we put into our body.

Some side effects can include nausea, diarrhea, vomiting, upset stomach. Many of these side effects go away over longer use of the medication. It is important to have a regular eye exam to be sure the medication is not building up in the eye, which can occur in severe cases.4 Hydroxychloroquine can be used from mild to severe disease and has a longstanding safety history.

The use of hydroxychloroquine in lupus can have many benefits for those suffering from mild to severe symptoms.