Abstract
OBJECTIVE: To report clinical experience from patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who were receiving recommended doses of hydroxychloroquine for more than six years, and were monitored for evidence of hydroxychloroquine related retinopathy every six months. METHODS: A prospective (and continuing) evaluation was made of the potential retinal toxicity of hydroxychloroquine in a cohort of 360 Greek patients followed for RA and SLE, 58 of whom have received long term treatment ( > six years). Fundoscopy, colour vision tests, dark adaptation tests, visual field testing, automated perimetry, and electroretinogram were performed every six months. RESULTS: Among 58 patients receiving hydroxychloroquine for more than six years, two relatively young women (3.5%), one treated for RA and the other treated for SLE, developed characteristic hydroxychloroquine related toxic retinal lesions after cumulative doses of 700 g (6.5 years) and 730 g (8 years) of hydroxychloroquine, respectively. Bilateral visual acuity was 6/6 and 6/7.5, respectively; both patients had normal colour perception. Despite an early diagnosis and cessation of treatment, permanent visual field paracentral scotomata in both patients, and persisting lesions in fluorescein angiography in the patient with SLE, were observed at 4.5 and 3 years of follow up, respectively. No other specific cases of hydroxychloroquine related retinopathy have to date been identified in the remaining 302 patients. CONCLUSION: Cases of irreversible, hydroxychloroquine related retinopathy in patients who did not receive overdoses have not been reported previously. The present observations in two relatively young patients should raise our concern regarding the long term usage of an increasingly popular medication in rheumatology practice.
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- Bernstein H. N. Ocular safety of hydroxychloroquine sulfate (Plaquenil). South Med J. 1992 Mar;85(3):274–279. doi: 10.1097/00007611-199203000-00010. [DOI] [PubMed] [Google Scholar]
- Easterbrook M. The ocular safety of hydroxychloroquine. Semin Arthritis Rheum. 1993 Oct;23(2 Suppl 1):62–67. doi: 10.1016/s0049-0172(10)80009-5. [DOI] [PubMed] [Google Scholar]
- Felson D. T., Anderson J. J., Meenan R. F. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum. 1990 Oct;33(10):1449–1461. doi: 10.1002/art.1780331001. [DOI] [PubMed] [Google Scholar]
- Finbloom D. S., Silver K., Newsome D. A., Gunkel R. Comparison of hydroxychloroquine and chloroquine use and the development of retinal toxicity. J Rheumatol. 1985 Aug;12(4):692–694. [PubMed] [Google Scholar]
- Fox R. I. Mechanism of action of hydroxychloroquine as an antirheumatic drug. Semin Arthritis Rheum. 1993 Oct;23(2 Suppl 1):82–91. doi: 10.1016/s0049-0172(10)80012-5. [DOI] [PubMed] [Google Scholar]
- Lanham J. G., Hughes G. R. Antimalarial therapy in SLE. Clin Rheum Dis. 1982 Apr;8(1):279–298. [PubMed] [Google Scholar]
- Mackenzie A. H. Dose refinements in long-term therapy of rheumatoid arthritis with antimalarials. Am J Med. 1983 Jul 18;75(1A):40–45. doi: 10.1016/0002-9343(83)91269-x. [DOI] [PubMed] [Google Scholar]
- Morsman C. D., Livesey S. J., Richards I. M., Jessop J. D., Mills P. V. Screening for hydroxychloroquine retinal toxicity: is it necessary? Eye (Lond) 1990;4(Pt 4):572–576. doi: 10.1038/eye.1990.79. [DOI] [PubMed] [Google Scholar]
- Stafford-Brady F. J., Urowitz M. B., Gladman D. D., Easterbrook M. Lupus retinopathy. Patterns, associations, and prognosis. Arthritis Rheum. 1988 Sep;31(9):1105–1110. doi: 10.1002/art.1780310904. [DOI] [PubMed] [Google Scholar]
- Wallace D. J. Antimalarial agents and lupus. Rheum Dis Clin North Am. 1994 Feb;20(1):243–263. [PubMed] [Google Scholar]