Öz
Kına kına ağacından elde edilen kininlerin sıtmada kullanılmalarına ait serüven ve sonrasında olanlar
ne kadar ilginç ise ilk defa romatizmal hastalıklarda kullanılmaları da o kadar ilginçtir. İkinci Dünya
Savaşında sıtmaya yakalanıp kinin ile tedavi edilen romatoid artritli Amerikalı askerlerin romatoid
artritlerinin iyileştiğinin fark edilmesinin, kininlerin romatizmal hastalıklarda kullanılmasına neden
olduğu söylenir. Kininlerin romatolojik hastalıklarda Klorokin (Chloroquine), Kinakrin (Quinacrine) ve
Hidroksiklorokin (Hydroxychloroquine) formları kullanılır. Anti-malaryaller romatolojik hastalıklarda
sıklıkla kullanılan, GİS (gastrointestinal sistem) emilimi çok iyi, güvenli, oldukça etkili ve 2-3 ay gibi
uzun etkili ilaçlardır. Esas olarak hem kendisi hem de hepatik metabolitleri böbrekten atıldıkları için
renal fonksiyonlar azaldığında doz azaltılması gerekir. Anti-inflamatuar etkileri pek çok noktada oluşur
ancak hangisi temel mekanizmadır bugün için bilinmemektedir. Hipoglisemik etkileri vardır. Bu etki
bazı olgularda önemli olabilir. Alerjik cilt reaksiyonları, psikozis, epilepsi benzeri ataklar, miyopati ve
retinal hasarlar gibi ciddi yan etkiler oldukça nadirdir. Daha sık görülenler bulantı-kusma ve dispepsi
gibi GİS yan etkileridir. Göz kontrolü tedaviye başlamadan önce mutlaka yapılıp, ilk beş yılda kontrol
periyodları bireyselleştirilmeli, beş yıldan sonra en az yılda bir yapılmalıdır. Olgu 80 kg üzerinde ise
günlük 400 mg başlangıç doz ile başlanabilir. 80 kg altında 5 mg/kg doz üstüne çıkılmazsa oküler ve
renal yan etkiler nadirdir. Gebelikte renal fonksiyonlar normal olduğunda güvenle kullanılabilir.
Anahtar Kelimeler
Kaynakça
- K. Hüsnü Can Başer, “Kinin‟in hikâyesi,” TAB Bülteni, Sayı 10 (1994), s.17-23.
- Rynes RI. Antimalarial Drugs. In: Kelly WN, Harris ED Jr, Ruddy S, Sledge CB (eds). Textbook of Rheumatology, 5th Ed, WB Saunders, Philadelphia 1997. 747-58.
- Rynes RI. Antimalarial drugs. In: Ruddy S, Harris ED Jr, Sledge CB (eds). Kelley‟s Textbook of Rheumatology. 6th Ed. Philadelphia:WB Saunders; 2001. p.859-67.
- Tett SE, Cutler DJ, Day RO. Bioavailability of hydroxychloroquine tablets assessed with deconvolution techniques. J Pharm Sci 1992; 81: 155-9.
- Furst DE. Pharmacokinetics of hydroxychloroquine and chloroquine during treatment of rheumatic diseases. Lupus 1996; 5 Suppl 1:S11-5.
- Rynes RI. Antimalarial drugs in the treatment of rheumatological diseases. Br J Rheumatol 1997;36(7):799-805.
- Furst DE, Lindsley H, Baethge B, et al. Dose-loading with hydroxychloroquine improves the rate of response in early, active rheumatoid arthritis: a randomized, double-blind six-week trial with eighteen-week extension. Arthritis Rheum 1999; 42: 357-65.
- Munster T, Gibbs JP, Shen D, et al. Hydroxychloroquine concentration-response relationships in patients with rheumatoid arthritis. Arthritis Rheum 2002; 46: 1460-9. Aponte J, Petrelli M, von Dawson N. Liver enzyme levels in arthritis patients treated with long-term bolus methotrexate. Arthritis Rheum 1992; 35: 126-8.
- Gladman DD, Urowitz MB, Senécal JL, et al. Aspects of use of antimalarials in systemic lupus erythematosus. J Rheumatol 1998; 25: 983-5.76 Ege Tıp Dergisi / Ege Journal of Medicine
- Felson DT, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum 1990; 33: 1449-61.
- Jallouli M, Francès C, Piette JC, et al. Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus: a case-control study. JAMA Dermatol 2013; 149: 935-40.
- Bahloul E, Jallouli M, Garbaa S, et al. Hydroxychloroquine-induced hyperpigmentation in systemic diseases: prevalence, clinical features and risk factors: a cross-sectional study of 41 cases. Lupus 2017; 26: 1304-8.
- Mosak J, Furie R. Comparative safety of therapies in systemic lupus erythematosus. Rheum Dis Clin North Am 2012; 38: 795-807.
- Sorbara S, Cozzani E, Rebora A, Parodi A. Hydroxychloroquine in psoriasis: is it really harmful? Acta Derm Venereol 2006; 86: 450-1.
- Estes ML, Ewing-Wilson D, Chou SM, et al. Chloroquine neuromyotoxicity. Clinical and pathologic perspective. Am J Med 1987; 82: 447-55.
- Casado E, Gratacós J, Tolosa C, et al. Antimalarial myopathy: an underdiagnosed complication? Prospective longitudinal study of 119 patients. Ann Rheum Dis 2006; 65(3):485-90.
- Lyons JS, Severns ML. Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity: a review Review of mfERG ring ratios in Plaquenil toxicity. Doc Ophthalmol 2009; 118: 29-36.
- Marmor MF, Hu J. Effect of disease stage on progression of hydroxychloroquine retinopathy. JAMA Ophthalmol 2014; 132:1105-12.
- Marmor MF, Carr RE, Easterbrook M, et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology 2002; 109 (7): 1377-82.
- Rynes RI, Bernstein HN. Ophthalmologic safety profile of antimalarial drugs. Lupus 1993; 2 Suppl 1:S17-9.
- Block JA. Hydroxychloroquine and retinal safety. Lancet 1998; 351(9105): 771.
- Rosenbaum JT, Mount GR, Youssef J, Lin P. New Perspectives in Rheumatology: Avoiding Antimalarial Toxicity. Arthritis Rheumatol 2016; 68: 1805-9.
- Wolfe F, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62: 775-84.
- Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol 2014; 132: 1453-60.
- Wallace DJ. Antimalarial therapies. In: Dubois' Lupus Erythematosus, 7th edition, Wallace, DJ, Hahn, BH (Eds), Williams & Wilkins, Baltimore 2007. 1152-74.
- Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MA. Clinical efficacy and side effects of antimalarials in SLE: a systematic review. Ann Rheum Dis 2010; 69: 20-8.
- Ruiz-Irastorza G, Egurbide MV, Pijoan JI, et al. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus 2006; 15: 577-83.
- Sisó A, Ramos-Casals M, Bové A, et al. Previous antimalarial therapy in patients diagnosed with lupus nephritis: influence on outcomes and survival. Lupus 2008; 17: 281-8.
- Lafyatis R, York M, Marshak-Rothstein A. Antimalarial agents: closing the gate on Toll-like receptors? Arthritis Rheum 2006; 54: 3068-70.
- Costedoat-Chalumeau N, Amoura Z, Hulot JS, et al. Low blood concentration of hydroxychloroquine is a marker for and predictor of disease exacerbations in patients with systemic lupus erythematosus. Arthritis Rheum 2006; 54: 3284-90.
- Durcan L, Clarke WA, Magder LS, Petri M. Hydroxychloroquine blood levels in systemic lupus erythematosus: clarifying dosing controversies and ımproving adherence. J Rheumatol 2015; 42: 2092-7.
- Furst DE, Lindsley H, Baethge B, et al. Dose-loading with hydroxychloroquine improves the rate of response in early, active rheumatoid arthritis: a randomized, double-blind six-week trial with eighteen-week extension. Arthritis Rheum 1999; 42: 357-65.
- Gerstein HC, Thorpe KE, Taylor DW, Haynes RB. The effectiveness of hydroxychloroquine in patients with type 2 diabetes mellitus who are refractory to sulfonylureas--a randomized trial. Diabetes Res Clin Pract 2002; 55: 209-19.
- Wasko MC, Hubert HB, Lingala VB, et al. Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis. JAMA 2007; 298: 187-93
Öz
Using of the quinines in rheumatic diseases for the first time is interesting as much as the adventure of
the use of quinines obtained from the Cinchona tree for malaria. American soldiers with rheumatoid
arthritis who were infected with malaria and treated with quinine in the Second World War were
reported to have recovered from rheumatoid arthritis. Quinines, used in rheumatologic diseases, are
Chloroquine, Quinacrine and Hydroxychloroquine. GIS (gastrointestinal system) absorption of antimalarials commonly used in rheumatologic diseases is very good, safe, and highly effective and longacting such as 2-3 months. Because both quinine and its hepatic metabolites are excreted from the
kidney, the dose should be reduced when renal function decreases. Anti-inflammatory effects occur at
many points, but which is the main mechanism is not known for today. It has hypoglycemic effects.
This effect may be important in some cases. Serious side effects such as allergic skin reactions,
psychosis, epilepsy-like seizures, myopathy, and retinal damage are extremely rare. More common
are GIS side effects such as nausea, vomiting and dyspepsia. Ophthalmologic examination must be
performed before starting treatment and control periods should be individualized in the first 5 years
and after 5 years at least once a year. If the case is over 80 kg, it can be started with an initial dose of
400 mg per day. It can also be used safely when renal functions are normal during pregnancy.
Anahtar Kelimeler
Kaynakça
- K. Hüsnü Can Başer, “Kinin‟in hikâyesi,” TAB Bülteni, Sayı 10 (1994), s.17-23.
- Rynes RI. Antimalarial Drugs. In: Kelly WN, Harris ED Jr, Ruddy S, Sledge CB (eds). Textbook of Rheumatology, 5th Ed, WB Saunders, Philadelphia 1997. 747-58.
- Rynes RI. Antimalarial drugs. In: Ruddy S, Harris ED Jr, Sledge CB (eds). Kelley‟s Textbook of Rheumatology. 6th Ed. Philadelphia:WB Saunders; 2001. p.859-67.
- Tett SE, Cutler DJ, Day RO. Bioavailability of hydroxychloroquine tablets assessed with deconvolution techniques. J Pharm Sci 1992; 81: 155-9.
- Furst DE. Pharmacokinetics of hydroxychloroquine and chloroquine during treatment of rheumatic diseases. Lupus 1996; 5 Suppl 1:S11-5.
- Rynes RI. Antimalarial drugs in the treatment of rheumatological diseases. Br J Rheumatol 1997;36(7):799-805.
- Furst DE, Lindsley H, Baethge B, et al. Dose-loading with hydroxychloroquine improves the rate of response in early, active rheumatoid arthritis: a randomized, double-blind six-week trial with eighteen-week extension. Arthritis Rheum 1999; 42: 357-65.
- Munster T, Gibbs JP, Shen D, et al. Hydroxychloroquine concentration-response relationships in patients with rheumatoid arthritis. Arthritis Rheum 2002; 46: 1460-9. Aponte J, Petrelli M, von Dawson N. Liver enzyme levels in arthritis patients treated with long-term bolus methotrexate. Arthritis Rheum 1992; 35: 126-8.
- Gladman DD, Urowitz MB, Senécal JL, et al. Aspects of use of antimalarials in systemic lupus erythematosus. J Rheumatol 1998; 25: 983-5.76 Ege Tıp Dergisi / Ege Journal of Medicine
- Felson DT, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum 1990; 33: 1449-61.
- Jallouli M, Francès C, Piette JC, et al. Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus: a case-control study. JAMA Dermatol 2013; 149: 935-40.
- Bahloul E, Jallouli M, Garbaa S, et al. Hydroxychloroquine-induced hyperpigmentation in systemic diseases: prevalence, clinical features and risk factors: a cross-sectional study of 41 cases. Lupus 2017; 26: 1304-8.
- Mosak J, Furie R. Comparative safety of therapies in systemic lupus erythematosus. Rheum Dis Clin North Am 2012; 38: 795-807.
- Sorbara S, Cozzani E, Rebora A, Parodi A. Hydroxychloroquine in psoriasis: is it really harmful? Acta Derm Venereol 2006; 86: 450-1.
- Estes ML, Ewing-Wilson D, Chou SM, et al. Chloroquine neuromyotoxicity. Clinical and pathologic perspective. Am J Med 1987; 82: 447-55.
- Casado E, Gratacós J, Tolosa C, et al. Antimalarial myopathy: an underdiagnosed complication? Prospective longitudinal study of 119 patients. Ann Rheum Dis 2006; 65(3):485-90.
- Lyons JS, Severns ML. Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity: a review Review of mfERG ring ratios in Plaquenil toxicity. Doc Ophthalmol 2009; 118: 29-36.
- Marmor MF, Hu J. Effect of disease stage on progression of hydroxychloroquine retinopathy. JAMA Ophthalmol 2014; 132:1105-12.
- Marmor MF, Carr RE, Easterbrook M, et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology 2002; 109 (7): 1377-82.
- Rynes RI, Bernstein HN. Ophthalmologic safety profile of antimalarial drugs. Lupus 1993; 2 Suppl 1:S17-9.
- Block JA. Hydroxychloroquine and retinal safety. Lancet 1998; 351(9105): 771.
- Rosenbaum JT, Mount GR, Youssef J, Lin P. New Perspectives in Rheumatology: Avoiding Antimalarial Toxicity. Arthritis Rheumatol 2016; 68: 1805-9.
- Wolfe F, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62: 775-84.
- Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol 2014; 132: 1453-60.
- Wallace DJ. Antimalarial therapies. In: Dubois' Lupus Erythematosus, 7th edition, Wallace, DJ, Hahn, BH (Eds), Williams & Wilkins, Baltimore 2007. 1152-74.
- Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MA. Clinical efficacy and side effects of antimalarials in SLE: a systematic review. Ann Rheum Dis 2010; 69: 20-8.
- Ruiz-Irastorza G, Egurbide MV, Pijoan JI, et al. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus 2006; 15: 577-83.
- Sisó A, Ramos-Casals M, Bové A, et al. Previous antimalarial therapy in patients diagnosed with lupus nephritis: influence on outcomes and survival. Lupus 2008; 17: 281-8.
- Lafyatis R, York M, Marshak-Rothstein A. Antimalarial agents: closing the gate on Toll-like receptors? Arthritis Rheum 2006; 54: 3068-70.
- Costedoat-Chalumeau N, Amoura Z, Hulot JS, et al. Low blood concentration of hydroxychloroquine is a marker for and predictor of disease exacerbations in patients with systemic lupus erythematosus. Arthritis Rheum 2006; 54: 3284-90.
- Durcan L, Clarke WA, Magder LS, Petri M. Hydroxychloroquine blood levels in systemic lupus erythematosus: clarifying dosing controversies and ımproving adherence. J Rheumatol 2015; 42: 2092-7.
- Furst DE, Lindsley H, Baethge B, et al. Dose-loading with hydroxychloroquine improves the rate of response in early, active rheumatoid arthritis: a randomized, double-blind six-week trial with eighteen-week extension. Arthritis Rheum 1999; 42: 357-65.
- Gerstein HC, Thorpe KE, Taylor DW, Haynes RB. The effectiveness of hydroxychloroquine in patients with type 2 diabetes mellitus who are refractory to sulfonylureas--a randomized trial. Diabetes Res Clin Pract 2002; 55: 209-19.
- Wasko MC, Hubert HB, Lingala VB, et al. Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis. JAMA 2007; 298: 187-93
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Ocak 2021 |
| Gönderilme Tarihi | 6 Nisan 2020 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 60 Özel Sayı:1 (Romatoloji) |
