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Antimalarials for Juvenile Idiopathic Arthritis

Examples

Generic Name Brand Name
hydroxychloroquine Plaquenil

How It Works

Antimalarial medicines (normally used to prevent and treat malaria) are sometimes used in an attempt to reduce inflammation associated with juvenile idiopathic arthritis (JIA).

Why It Is Used

Antimalarial medicines may be used along with nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis that has not responded to NSAIDs alone. This combination is more commonly used to treat progressive polyarticular arthritis but can be used for any form of JIA.

How Well It Works

Although some people get better with antimalarials, a large study of the effects of antimalarial treatment for JIA showed them to be no better than a placebo.1 It may take up to 16 weeks to see an effect from hydroxychloroquine. The medicine is usually discontinued if no improvement is seen after 16 weeks.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine your child takes. Side effects are also listed in the information that comes with the medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after your child takes the medicine for a while.
  • If side effects still bother your child and you wonder if he or she should keep taking the medicine, call your doctor. He or she may be able to lower the dose or change the medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if your child has:

  • Trouble breathing.
  • Hives.
  • Swelling of his or her face, lips, tongue, or throat.

Call your doctor right away if your child has any blurred vision, problems seeing to read, or changes in vision. Your doctor may have you check your child's vision at least once a month using an Amsler grid, which is a chart with lines and a dot at the center that lets you monitor changes in vision. If you or your child notices any changes in vision or changes in his or her view of the Amsler grid, call your doctor.

Common side effects of this medicine include:

  • Diarrhea.
  • Itching.
  • Headache.
  • Nausea or vomiting.
  • Stomach cramps.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Some antimalarial medicines, such as hydroxychloroquine, can cause serious and permanent damage to the retina of the eye. When appropriate doses are given, this is rare. If it is found early, eye damage may be reversed and permanent damage may be prevented. So your child should have an initial ophthalmic examination before beginning antimalarial therapy and examinations if and when you or your child notices a change in vision. Your doctor may recommend visits to the ophthalmologist as often as every 3 to 12 months, depending on your child's vision and your doctor's level of concern about eye disease from JIA.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. If your child takes medicine as your doctor suggests, it will improve your child's health and may prevent future problems. If your child doesn't take the medicines properly, his or her health (and perhaps life) may be at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Checkups

Follow-up care is a key part of your child's treatment and safety. Be sure to make and go to all appointments, and call your doctor if your child is having problems. It's also a good idea to know your child's test results and keep a list of the medicines your child takes.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Nistala K, et al. (2009). Juvenile idiopathic arthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1657–1675. Philadelphia: Saunders Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer John Pope, MD - Pediatrics
Specialist Medical Reviewer Stanford M. Shoor, MD - Rheumatology
Last Revised June 11, 2010

Last Revised: June 11, 2010

Author: Healthwise Staff

Medical Review: John Pope, MD - Pediatrics & Stanford M. Shoor, MD - Rheumatology

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