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Chloroquine and Hydroxychloroquine: A Closer Look on Skeletal Muscle

Alzira Alves de Siqueira Carvalho

Chloroquine (CQ) and Hydroxychloroquine (HCQ), antimalarial agents and widely used in the treatment of autoimmune diseases are considered safe nonetheless, they can provoke side effects, including myopathy. Literature data regarding the prevalence and incidence of this toxic myopathy are scarce and main symptoms encompass Proximal Muscle Weakness (PMW) and normal or slightly elevated creatine kinase (CK) levels. So, definitive diagnosis requires muscle biopsy, showing autophagic vacuoles and curvilinear bodies. The results from a literature review, revealed PMW in 87.2% and respiratory distress in 12.5% of patients; dysphagia, cervical and axial weakness in 8.9%, 17.8%, and 1.8%, respectively. Elevated CK levels in 60.7%, EMG with myopathic pattern in 54% and vacuolar myopathy in 53.7% associated to “curvilinear bodies” in 86.8%. The recovery after discontinuation of therapy occurred in 85.4%. Clinicians should be aware about this possible condition. Even with normal CK levels, muscle biopsy must be the gold-standard tool to diagnose and differentiate patients with this condition from other neuromuscular disorders.