Hydroxychloroquine Is Safe and Probably Useful in Rheumatoid Arthritis

The history of antimalarial drug therapy in rheumatoid arthritis has several distinct phases. The first was a fairly widespread enthusiasm for the drugs [1]. For example, Freedman and Steinberg [2] reported a definite general improvement in 85 of 107 (80%) patients who completed 1 year of chloroquine treatment, compared with 30% of the placebo group. Whereas 25% of the control patients were clinically deteriorating, only 5% of the patients treated with chloroquine lost ground during the study. This enthusiasm was fueled by the disillusionment in the 1950s with corticosteroids as a primary therapy because of the destructive toxicity of prednisone or its equivalent used in doses greater than 10 mg/d. In addition, no satisfactory, nontoxic, nonsteroidal drugs were available as a substitute for aspirin.

In 1959, however, the report by Hobbes and colleagues [3] that linked an irreversible retinopathy with chloroquine therapy precipitated a distinct decline in the use of antimalarial agents for rheumatoid arthritis. This disillusionment with the drugs may have reflected the general feeling that they were not as useful as gold salts, as well as the misconception that rheumatoid arthritis was not a disease that led to an increased mortality rate or needed particularly …