Quinacrine Ochronosis and Rheumatoid Arthritis

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Abstract
BLUE-BLACK mucocutaneous hyperpigmentation has been reported as a consequence of therapy with quinacrine hydrochloride and related antimalarial drugs.1-3 Similar discoloration occurs with the metabolic disorder alcaptonuria and is associated with pigment deposition in articular cartilage and premature degenerative joint disease. Ludwig et al4 reported a single case of quinacrine ochronosis and postulated an association between the pigmentation of the skin and premature lumbar degenerative arthropathy. Joint tissue has not, however, been described in any case of antimalarial hyperpigmentation. This report describes a patient treated for rheumatoid arthritis with quinacrine in whom the classic skin changes of antimalarial ochronosis developed. In the course of her management, joint tissue became available for histologic study; the findings of the examination of this tissue form the basis for this report. Report of a Case A 58-year-old woman had a 25-year history of chronic deforming rheumatoid arthritis. Her course has been one of

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