Chloroquine’s effect on the body
· A disease-modifying Methotrexate is an animetabolite-type cytotoxic agent. It has been used to suppress various malignant diseases.
· In

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low dosages it can reduce inflammation,  but it is not a pain killer. 
· It can reduce the activity of the immune system, thus reducing signs and symptoms of rheumatic disease by slowing the progression of the disease.
· This drug acts by interfering with folic synthesis, and many of the adverse effects can be avoided by use of folic acid (1 – 5 mg per day)
· It does not lead to remission in all cases
· Beware of potential serious side-effects on the body. Careful monitoring essential.

Who can benefit from chloroquine?
· Some people with rheumatic arthritis not responding sufficiently to non-drug measures and NSAID’s,
· People with active synovitis
· People in early stages of the disease
· People younger than 70 years

When and how do I take cholorquine?
Methotrexate in tablet form should be taken:
· once a week on the same day of the week,
· with food. 
· It should be swallowed whole and not chewed or crushed.
· It can also be injected once a week, either under the skin or into the muscle.

What dose do I take?
· Methotrexate tablets, available in 2.5 mg and 10 mg doses, look so similar that you should always check that you take the correct dose.
· Your doctor will usually start you off with 7,5 mg – 10 mg per week, and then increase the weekly dose by 2,5 mg for 2 –4 weeks till the optimal response is achieved.
· The maximum dose is 20 mg per week.
· Add a folate supplement of 5 mg per day
· If 20 mg per week for 6 months does not lead to benefits, it is considered failure of therapy 

How soon will I see results?
Methotrexate is regarded as rapid-acting, but it does not work immediately. It may take 3 to 12 weeks before you may feel better.

What are the potential side-effects?
· The adverse effects are minimal with low dose therapy.
· In some people methotrexate can affect the gastro-intestinal tract and can cause diarrhoea and/or nausea,
· It may cause mouth ulcers, hair loss and skin rashes, pigmentary changes
· It may increase the uric acid concentrations in the blood to such an extent that it may precipitate an acute attack of gout.
· It may suppress bone marrow function, and affecting the blood count. With fewer blood cells produced, the likelihood of infections increases.
· It may damage the liver and/or kidneys
· In some cases it may cause hypersensitivity pneumonitis (inflammation of the lung) with breathlessness. If you become breathless, you should see your doctor immediately.
· Headaches, drowsiness, fatigue and blurred vision may result.
· RED ALERT: a person on methotrexate with a sore throat and high fever, should be admitted to hospital very urgently. If you develop a sore throat, or other infection, or a fever, or unexplained bruising or bleeding, or any new symptoms after starting methotrexate, you should see your doctor urgently.
· If you have not had chicken-pox but come into contact with someone with chicken-pox or shingles, or if you develop shingles or chicken-pox while taking methotrexate, you should see your doctor immediately. You may need special treatment.
· 5 mg of folic acid per day can reduce the likelihood of side-effects.

Do I need any special monitoring while on chloroquine?
Yes.
· Your blood counts (including hemoglobin count, white cell count and platelets) should be monitored carefully and regularly prior to and during treatment.
· Your liver function should be monitored two weeks after starting therapy and then monthly for 3 months, followed by three-monthly checks.

Can I take other medication while on chloroquine?
Some drugs will interact with methotrexate and should be avoided or use with great care. 
· Aspirin and non-steroidal anti-inflammatory drugs inhibits the kidneys’ ability to metabolize the drug and the risk of renal damage increases
· Phenytoin, trimethoprim, cotrimoxazole and triamterene may increase the risk of methotrexate toxicity.
· Methotrexate may increase uric acid blood concentrations – person may need more allopurinol and benzbromarone, the medication prescribed to reduced elevated blood uric acid levels.
· Monitor the use of anti-clotting agents carefully as methotrexate may inhibit the synthesis of clotting factor.
· No vaccination with live virus vaccines. Thus no vaccination against polio, rubella (German Masles) or yellow fever. Flu vaccines are safe.
· Avoid sulphonamide antibiotics

What about chloroquine and pregnancy and breastfeeding?
It can reduce fertility and is likely to harm the unborn baby.
Take contraceptive precautions while taking methotrexate and even for 6 months after methotrexate is stopped. Inform your doctor as soon as possible if you fall pregnant while on methotrexate.
Do not use while pregnant or breastfeeding. 

What about alcohol while taking chloroquine?
Alcohol enhances the risk of liver damage, and should be avoided

Read more:
Osteoarthritis: The treatment
Rheumatoid arthritis and your sex life

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