Chloroquine-induced myopathy

Posada, Celia; García-Cruz, A.; García‐Doval, I.; Millán, Beatriz San; Teijeira, Susana

doi:10.1177/0961203310385553

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…Their amphiphilic properties elevate intralysosomal pH causing specific lysosomal disarrangement and autophagic dysfunctions, which result in vacuolar changes in muscle. They also specifically inhibit the lysosomal proteinase, cathepsin B, responsible for intracellular proteolysis [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

Carvalho

2020

Curr Pharmacol Rep

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Purpose of Review Concerning adverse neuromuscular effects, there are quite a few reports about the incidence and prevalence of chloroquine (CQ) and hydroxychloroquine (HCQ) myopathy. Given the above, I decided to explore the relationships of these drugs with skeletal muscle in an attempt to clarify how they affect the muscle now and in the future, as millions of people are using CQ and HCQ. Recent Findings The literature review identified 28 publications about CQ/HCQ myopathy, totaling 56 patients, from 1963 to 2020. A compilation of all patients was carried out by computing demographic features, clinical aspects, laboratory exams, and clinical evolution. All articles but two represented a large series about incidence and prevalence of the myopathy. Fifty-nine percent used QC, mean daily dose was 393 mg per day, and mean duration of treatment was 37 months. The predominant underlying diseases were rheumatoid arthritis (42.8%) and lupus erythematosus (26.8%). Respiratory distress was present in 12.5% in patients with proximal muscle weakness (87.2%). Dysphagia and cervical and axial weakness were observed in a smaller percentage. Creatine kinase was elevated in 60.7%, and EMG showed a myopathic pattern in 54%. Muscle biopsy showed a vacuolar pattern in 53.7%, and curvilinear bodies (CB) were the predominant ultrastructural finding (86.8%). After drug withdrawal, 85.4% of patients improved, and 12.7% died from other causes than myopathy. Summary CQ and HCQ myopathy has been known for a long time, but the incidence is low, being described only with long-term use. The use of these drugs for a short period has not been reported, although a prolonged elimination half-life of these drugs actually exists.

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Section: Discussionmentioning

confidence: 99%

Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

Carvalho

2020

Curr Pharmacol Rep

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“…HCQ is known to raise intra‐lysosomal pH via accumulation in lysosomes leading to subsequent inhibition of activities of cathepsin B, mucopolysaccharidases, acid maltase, acid phosphodiesterase and most other acidic lysosomal hydrolases . This leads to intracellular accumulation of phospholipid, glycogen and subsequently curvilinear bodies and lamellar structures called myeloid bodies …”

Section: Discussionmentioning

confidence: 99%

“…Confirmation of the diagnosis can be made via ultrastructural examination of the tissues to detect cytoplasmic complex autophagic and curvilinear bodies. Curvilinear bodies, seen only in HCQ/chloroquine myopathy and ceroid lipofuscinosis (rare form of lipopigment storage disease), are considered pathognomonic for HCQ myopathy . However, the clinical significance of these curvilinear bodies is uncertain in HCQ toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…14,17 This leads to intracellular accumulation of phospholipid, glycogen and subsequently curvilinear bodies and lamellar structures called myeloid bodies. [18][19][20] HCQ is also known to inhibit cytokine production and release, as well as decreasing Toll-like receptor −9, −8, −7 and −3 activation via insertion into membranes owing to its nature of being a weak base. 21,22 This results in histopathological findings of fiber digestion and distinctive cytosome formation with curvilinear profiles and lipofuscin.…”

Section: Discussionmentioning

confidence: 99%

“…Curvilinear bodies, seen only in HCQ/chloroquine myopathy and ceroid lipofuscinosis (rare form of lipopigment storage disease), are considered pathognomonic for HCQ myopathy. 19,20 However, the clinical significance of these curvilinear bodies is uncertain in HCQ toxicity. The development of curvilinear bodies does not appear to be related to the dose of HCQ as Khoo et al did not find an association between curvilinear bodies with HCQ dosing when comparing both the cumulative dose as well as the dose adjusted for body weight or body mass index.…”

Section: Discussionmentioning

confidence: 99%

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Hydroxychloroquine‐induced autophagic vacuolar myopathy with mitochondrial abnormalities

Khosa

Khanlou²,

Khosa

et al. 2018

Neuropathology

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Hydroxychloroquine (HCQ) and chloroquine are used worldwide for malaria as well as connective and rheumatological disorders. They have been reported to be linked to myopathy in patients. We report four patients who were receiving HCQ as part of treatment for connective tissue disorder and who presented with myopathy. The muscle biopsy in these patients was consistent with findings of HCQ toxicity. HCQ muscle toxicity is usually self‐limiting after discontinuation of the drug. It also usually tends to be under‐reported due to presence of various confounding factors. This warrants close monitoring and consideration of muscle biopsy as part of initial work up of patients who present with myopathy while receiving HCQ.

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Antimalarial myopathy in a systemic lupus erythematosus patient with quadriparesis and seizures: a case-based review

et al. 2017

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Weakness, seizures, and encephalopathy have a broad differential diagnosis in patients with systemic lupus erythematosus (SLE). We present a case of a 26-year-old female with a recent diagnosis of SLE who experienced a clinical deterioration with quadriparesis, seizures, and encephalopathy. Her quadriparesis was found to be secondary to biopsy-proven hydroxychloroquine-induced myopathy with concomitant inflammatory myopathy. Her seizures and encephalopathy were suspected to be multifactorial in the setting of sepsis and critical illness with possible contributions from neuropsychiatric manifestations of SLE and macrophage activation syndrome. She experienced a dramatic clinical recovery with discontinuation of hydroxychloroquine, treatment of lupus disease activity with mycophenolate mofetil and prednisone, and antibiotic treatment for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. This case-based review provides a systematic approach to quadriparesis, seizures, and encephalopathy in patients with SLE and an evidence-based discussion of antimalarial myopathy, which is of critical importance given the widespread use of antimalarial medications for rheumatologic diseases.

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Chloroquine-induced myopathy

Cited by 10 publications

References 9 publications

Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

Side Effects of Chloroquine and Hydroxychloroquine on Skeletal Muscle: a Narrative Review

Hydroxychloroquine‐induced autophagic vacuolar myopathy with mitochondrial abnormalities

Antimalarial myopathy in a systemic lupus erythematosus patient with quadriparesis and seizures: a case-based review

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