Hydroxychloroquine and Colchicine Induced Myopathy

Abstract

Hydroxychloroquine and colchicine neuromuscular toxicity is well documented. The largest literature review on colchicine myopathy was conducted by Wilbur and Makowsky in 2004 where a database search found 75 cases. Most patients presented with proximal muscle weakness. A wide range of treatment durations were noted (from 4 days to 11 yrs) with cumulative daily doses of 1.4 ± 0.96 mg. The toxicity became apparent in the majority of cases after changes in recent disease states such as decline in renal function, initiation of dialysis, or solid organ transplantation. A second myotoxic agent such as prednisone, lipid lowering agents, or cyclosporine were common1. We report a case with a stable glomerular filtration rate of 36.7 ml/min/1.73 m2. A 66-year-old woman was admitted to the hospital after being unable to stand after a minor fall. She had a 12 year history of seronegative rheumatoid arthritis (RA) treated with hydroxychloroquine 200 mg bid since diagnosis. The patient complained of progressive proximal upper and lower extremity painless muscle weakness since being discharged from the hospital for a bladder suspension surgery 4 weeks before. Her hospitalization was complicated by a postoperative gout flare of multiple metatarsophalangeals on the right, during which she was given colchicine as an inpatient and continued until presentation. She reported having similar mild symptoms of weakness for the previous 12 months also. Examination revealed the patient was 5 ft, 6 in, weighing 230 lbs with upper and lower extremity; proximal and distal muscle weakness with the most prominent weakness noted with hip flexor strength graded 3/5. She was unable to transfer without assistance. Quadracep deep tendon reflexes were +1 bilaterally with unobtainable bicep and tricep reflexes. No sensory deficits were noted. Scattered Heberden and Bouchard nodes noted along with near anklyosed left 3rd proximal interphalangeal and right … Address correspondence to Dr. Lonesky.