Background Since the early 50's, chloroquine (CQ) and hydroxychloroquine (HCQ) have been widely used for the treatment of rheumatoid arthritis and other similar inflammatory diseases. So far these medications are the drug of choice for many patients with rheumatologic problems. Ocular toxicity of HCQ and CQ including irreversible retinopathy is rare, but it has extremely high potential risk. Although the exact incidence of retinopathy is not clear but the probability of occurrence is 3-4% in patients taking these drugs for at least 10 years. Despite this, there is no general consensus on intervals and regularity of eye screening in patients treated with antimalarials
Objectives In this study, we investigated the incidence of ocular complications in our patients with rheumatoid arthritis (RA), SLE (systemic lupus erythematosus) or mixed connective tissue disease (MCTD) receiving HCQ or CQ and the rate of false positive results of routine eye examination
Methods In this retrospective study medical records of 598 patients with RA, SLE or MCTD taking antimalarial medications were evaluated. Individuals' demographic characteristics, duration of disease and treatment and also presence of other co morbidities were documented. The patients had undergone routine ophthalmological assessment. In case of ocular involvement, second ophthalmic examination was conducted by another expert ophthalmologist to ensure the routine ocular assessment
Results In this study 124 (20.7%) patients were male and 474 (79.3%) were female. Age of individuals was 50.6±14.6 years. Duration of treatment was 22.8±22 months for HCQ 200 mg, 15.4±15.8 months for HCQ 400 mg and 7.4±14.4 months for CQ 150 mg. No ophthalmic abnormality was detected in 515 (86.1%) subjects but ocular complications were diagnosed in 83 cases (13.9%) in the routine ophthalmic examination. Among these patients, Ocular toxicity of antimalarials was ruled out in 49 (8.2%) subjects in the second ophthalmological assessment. Therefore eye problems were confirmed in 34 (5.7%) cases. Patients with eye complications were significantly older than individuals without ocular toxicity (P=0.03). Ocular involvement was not significantly different between patients with RA, SLE or MCTD (P=.01) and between patients with and without comorbidities (P=0.7). Meanwhile duration of the underlying disease and also treatment with various antimalarial agents were not significantly different between patients with and without ocular toxicity (P>0.05)
Conclusions The findings indicated a considerable rate of ocular complications among patients receiving antimalarial drugs even after exclusion of some of the diagnosed cases in the second ophthalmic examination. Thus despite the controversial recommendations about routine screening for ocular complications resulting from treatment with antimalarial medications, we recommend regular screening to detect cases of ocular toxicity in all patients receiving these drugs
Wolfe F, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care & Research. 2010;62(6):775-84.
Tehrani R, Ostrowski RA, Hariman R, Jay WM, editors. Ocular toxicity of hydroxychloroquine. Seminars in ophthalmology; 2008: Informa UK Ltd UK.
Disclosure of Interest : None declared
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