title: Antimalarial myopathy: an underdiagnosed complication? Prospective longitudinal study of 119 patients.
abstract: OBJECTIVE
  To evaluate the prevalence and incidence of antimalarial myopathy in patients with rheumatic diseases treated with antimalarial drugs.
  
  
  METHODS
  Over a three year period, all patients with rheumatic diseases who were taking antimalarial drugs were studied. Serum muscle enzymes were assessed at the time of inclusion and every six months thereafter. Muscle strength, electromyography (EMG), and muscle biopsy were assessed in patients with a persistent muscle enzyme disturbances.
  
  
  RESULTS
  119 patients were included (111 chloroquine, eight hydroxychloroquine). Of these, 22 (18.5%) had a persistent muscle enzyme disturbance: lactate dehydrogenase 19/22 (86%); creatine kinase 7/22 (32%), and aldolase 3/22 (14%). Findings of antimalarial myopathy were detected in 3/15 biopsied patients (20%) by light microscopy and in all 15 by electron microscopy. Eleven patients had myopathy at the time of inclusion (prevalence 9.2%) and four patients developed muscle injury during follow up (annual incidence 1.2%). Muscle weakness was observed in 8 of 15 patients with biopsy proven myopathy, giving a prevalence of clinical antimalarial myopathy of 6.7%. All these patients also had a myopathic pattern on electromyography.
  
  
  CONCLUSIONS
  The prevalence of antimalarial myopathy is higher than previously recognised when muscle enzyme determination is used as a screening method. When a persistent muscle enzyme disturbance is observed, clinical and electromyographic studies should be undertaken periodically to detect the development of clinical myopathy. In cases of clinical myopathy, an anatomical-pathological tissue study, including an ultrastructural study, is mandatory to confirm the diagnosis.
authors.affiliation: Rheumatology Unit, Parc Taulí University Hospital, Parc Taulí s/n. 08208 Sabadell, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Casado
authors.forename: J
authors.initials: J
authors.lastname: Gratacós
authors.forename: C
authors.initials: C
authors.lastname: Tolosa
authors.forename: J M
authors.initials: JM
authors.lastname: Martínez
authors.forename: I
authors.initials: I
authors.lastname: Ojanguren
authors.forename: A
authors.initials: A
authors.lastname: Ariza
authors.forename: J
authors.initials: J
authors.lastname: Real
authors.forename: A
authors.initials: A
authors.lastname: Sanjuán
authors.forename: M
authors.initials: M
authors.lastname: Larrosa
mesh_terms: D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001706:Biopsy; D002738:Chloroquine / Q000009:adverse effects*; D004796:Clinical Enzyme Tests / Q000379:methods; D004576:Electromyography; D004798:Enzymes / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000201:enzymology / Q000503:physiopathology; D009135:Muscular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D012216:Rheumatic Diseases / Q000188:drug therapy*
chemical_list: D000962:Antimalarials; D018501:Antirheumatic Agents; D004798:Enzymes; D006886:Hydroxychloroquine; D002738:Chloroquine