Hydroxychloroquine (HCQ) and chloroquine (CQ) are well-established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)–prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID-19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus-based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long-term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk–benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases.

中文翻译：

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美国风湿病学会抗疟心脏毒性白皮书


羟氯喹 (HCQ) 和氯喹 (CQ) 是用于治疗系统性红斑狼疮和类风湿性关节炎以及皮肤红斑狼疮等皮肤病的成熟药物。在极少数情况下，有报道称心律失常、传导系统异常以及心肌病与 HCQ/CQ 的使用有关。然而，最近，这些药物的校正 QT 间期 (QTc) 延长潜力，特别是尖端扭转型室性心动过速 (TdP) 的风险，在其治疗 COVID-19 感染的实验中得到了强调。本报告旨在总结目前对 HCQ/CQ 心脏毒性的认识，描述 QTc 延长和 TdP 风险，并讨论未来研究的优先领域。由风湿病学、心脏病学和皮肤病学专家组成的工作组进行了非系统性文献综述，并提出了基于共识的专家意见。目前的数据清楚地表明，HCQ 和 CQ 是治疗风湿病和皮肤病的宝贵药物，但它们通过直接影响心脏复极而与 QTc 延长相关。开处方的临床医生应该认识到这种微小的影响，特别是对于服用延长 QTc 间期的其他药物的患者。长期使用 HCQ/CQ 可能导致与心律失常和心力衰竭相关的心肌病。在开始任何药物治疗之前应考虑风险和效益评估，并且初始和持续的风险效益评估对于 HCQ/CQ 处方都很重要。虽然与 HCQ/CQ 治疗风湿性疾病相关的心脏毒性很少有报道，但它可能是致命的。 了解 HCQ 和 CQ 的潜在不良心脏影响可以提高这些药物的安全使用。显然需要进行更多研究，以更好地了解这些用于治疗风湿病和皮肤疾病的疗法的心血管风险和安全性。