Reversible alopecia areata: a little known side effect of leflunomide.

Leflunomide is a disease-modifying anti-rheumatic drug (DMARD) used in the management of rheumatoid arthritis (RA) and psoriatic arthritis. Commonly reported adverse effects include diarrhea, nausea, hepatotoxicity, hypertension, and transient global hair loss; however, additional side effects may be associated with the medication not reported in the monograph. We describe a rare case of reversible alopecia areata (AA) associated with the use of leflunomide and provide a literature review of three published similar cases. We use the Naranjo adverse drug reaction score to show the AA in our case is a "probable" side effect of leflunomide. Currently, AA is not listed as an adverse effect in the leflunomide product monograph. However, it would appear that based on our case and the three other reported cases, the likelihood of AA being an adverse effect of leflunomide is at least possible to probable.

Antimalarial drugs alone may still have a role in rheumatoid arthritis.

OBJECTIVES: Antimalarials have been used for the treatment of rheumatoid arthritis (RA) for several decades. Current guidelines do not include the use of these drugs alone for RA patients. The purpose of the study is to review RA patients, to find those who have done well on antimalarials alone, and see if there are common features that predict good treatment outcome with these drugs. METHODS: This is a retrospective chart review of patients who have been successfully treated with antimalarials alone. Patients who were attending routine follow-up and were seemingly in remission defined by no swollen or tender joints were selected over a 6-month period. Those who had being doing well but were now or had been on other agents were not included. The background data were reviewed to see if there were any common initial characteristics. RESULTS: Thirty-three patients were seen who had been administered antimalarials alone and where initial data were available. Patients remain in clinical remission. Based on clinical observation, inflammatory markers, and radiographic reports, in the follow-up visits, they remain with no signs of inflammation and no new erosions on radiograph. Initial bone erosions on 2 patients remain stable over the years. CONCLUSIONS: There are some patients with confirmed RA who without doubt respond well to antimalarials alone. It is hard to objectively measure whether mild disease activity, early treatment initiation, lack of smoking, or other factors are contributing to a good treatment response.