Letter to the Editor

Huang, Po Hsun; Tuan, Ta Chuan; Lin, Yi-Hsien; Ding, Yu An; Kong, Chi Woon

doi:10.1191/0961203303lu435xx

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…The stimulation threshold can be modified in different situations, ranging from physiological states such as sleep and the postprandial period where the threshold increases, to pathological states such as ischemia, fibrosis, fluid electrolyte disorders such as dyskalemia, defibrillation, dysthroidism and finally drug intake [14].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, chloroquine, a molecule widely used in the treatment of RA, known for its property of blocking sodium and potassium channels such as hERG thus giving it an effect of class I and class III antiarrhythmics, is implicated according to cases in the literature in the increase of the stimulation threshold, this is probably explained by its blocking effect on sodium channels [14].…”

Section: Discussionmentioning

confidence: 99%

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2024

IJCMCR

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Rheumatoid Arthritis (RA) is a chronic autoimmune joint disease characterized by persistent systemic inflammation.In rheumatoid arthritis, cardiac involvement is not uncommon and may involve all three tunics of the heart. We report an exceptional case of RA associated with complete Atrioventricular Block (AVB) and intracardiac mobile mass. This is a patient with RA initially put on chloroquine, complicated by a complete BAV implanted with a double chamber pace, then put on corticosteroid therapy and methotrexate for four years. Faced with the worsening of his osteoporosis and the probable increase in the threshold of pacemaker stimulation, it was decided to replace methotrexate with leflunomide. As part of the patient's cardiac evaluation, an ETT was performed, inadvertently objectifying a mass in the right atrium attached to the atrial tube and the tricuspid valve without obstruction.Full BAV is very rare. It can be seen especially in old polyarthritis. Several mechanisms can explain this, including rheumatoid nodules; Chloroquine poisoning; amyloid infiltration and rheumatoid vasculitis.The association of RA and intracardiac mass is rare. By analyzing the few cases described in the literature, five main causes are summarized: rheumatoid nodules, cancers, granulomatosis of valves, intracavitary thrombus and infective endocarditis.We discuss through our case, the epidemiological and etiological particularity of the association of RA with a major conductive disorder, as well as the difficulty of the etiological diagnosis of an intracardiac mass in the context of RA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Untitled

2024

IJCMCR

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Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.

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Letter to the Editor

Cited by 2 publications

References 9 publications

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Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

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