- Visibility 280 Views
- Downloads 277 Downloads
- Permissions
- DOI 10.18231/j.ijceo.v.11.i.3.21
-
CrossMark
Comparitive study on short term and long term ocular side effects of hydroxychloroquine in rheumatoid arthritis and systemic lupus erythematosus
- Author Details:
-
Gandavarapu Asritha *
-
Radhakrishnan Balasubramanyam
-
Anusha Annapureddy
Gandavarapu Asritha *
Background: Hydroxychloroquine (HCQ), a derivative of chloroquine, is widely used to treat autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Despite its therapeutic benefits, HCQ can cause ocular toxicity, particularly retinal damage, which can lead to irreversible vision loss.
Aim and Objectives: This prospective comparative study aimed to investigate the short- and long-term ocular side effects of HCQ in RA and SLE patients.
Materials and Methods: This study included 160 patients who received HCQ doses > 6.5 mg/kg per day or had a cumulative dose exceeding 1000 g. The patients underwent comprehensive ocular examinations, including best-corrected visual acuity, slit-lamp examination, color vision testing, dilated fundus examination, optical coherence tomography, automated perimetry, Amsler grid testing, and fundus autofluorescence imaging.
Results: Among 160 patients, 65.6% were aged ≥50 years and 69.4% were female. Premaculopathy was the most common ocular manifestation (13.1%), followed by posterior subcapsular cataract (PSC) (9.4%) and bull's eye maculopathy (2.5%). A higher incidence of ocular side effects was noted in patients taking a daily dose of 400 mg, with PSC in 12.6% and premaculopathy in 15.2%. Kidney problems were 8.8%, with a higher prevalence in those using HCQ for ≤7 years (11.4%) compared to >7 years (5.6%). Visual acuity assessments revealed that patients receiving HCQ for ≤7 years had better outcomes, with 35.2% achieving 6/9 vision in the right eye, whereas those receiving treatment for >7 years showed a decline in visual acuity.
Conclusions: The increased recognition of HCQ-induced ocular toxicity is attributable to advances in imaging modalities, heightened clinical awareness, and the implementation of standardized screening guidelines. Asymptomatic patients can exhibit toxicity, which necessitates objective testing methods for early identification.
References
- Plantone D, Koudriavtseva T. Current and future use of chloroquine and hydroxychloroquine in infectious, immune, neoplastic, and neurological diseases: A mini-review. Clin Drug Investig. 2018;38(8):653–71.
- Mets MB, Brown A, Doan AP, Williams RD, Mills R, Erie JC, et al. The ophthalmologist of the future. Arch Ophthalmol 2012;130(9):1190–4.
- Lang GK, Gareis O. Ophthalmology: A pocket textbook atlas. Stuttgart: Thieme. 2007.
- Bruxvoort K, Goodman C, Kachur SP, Schellenberg D. How patients take malaria treatment: A systematic review of the literature on adherence to antimalarial drugs. PLoS One 2014;9:e84555.
- Quillen DA, Blodi BA, Bennett TJ. Clinical features of retinal disease. In: Quillen DA, Blodi BA, eds. Clinical retina. Chicago: AMA Press; 2002.
- Yam JCS, Kwok AKH. Ocular toxicity of hydroxychloroquine. Hong Kong Med J. 2006;12(4):294–304.
- Williams R, Hui A. Common systemic medications that every optometrist should know. Clin Exp Optom 2022;105:149–56.
- Melles RB, Jorge AM, Marmor MF, Zhou B, Conell C, Niu J, et al. Hydroxychloroquine dose and risk for incident retinopathy: A cohort study. Ann Intern Med 2023;176(2):166–73.
- Wong TY, Sun J, Kawasaki R, Ruamviboonsuk P, Gupta N, Lansingh VC, et al. Guidelines on diabetic eye care. Ophthalmology 2018;125(10):1608–22.
- Wolfe F, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2010;62(6):775–84.
- Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 2014;132(12):1453–60.
- Melles RB, Marmor MF. Pericentral retinopathy and racial differences in hydroxychloroquine toxicity. Ophthalmology. 2015;122(1):110–6.
- Garrity ST, Jung JY, Zambrowski O, Pichi F, Su D, Arya M, et al. Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects. Br J Ophthalmol. 2019;103(11):1600–4.
- Carvalho AAS. Side effects of chloroquine and hydroxychloroquine on skeletal muscle: a narrative review. Curr Pharmacol Rep. 2020;6(6):364–72.
- Mavrikakis I, Sfikakis PP, Mavrikakis E, Rougas K, Nikolaou A, Kostopoulos C, et al. The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal. Ophthalmology. 2003;110(7):1321–6.
- Graef S, Irwin MS, Wan MJ. Incidence and prognostic role of the ocular manifestations of neuroblastoma in children. Am J Ophthalmol. 2020;213:145–52.
- Almeida-Brasil CC, Hanly JG, Urowitz M, Clarke AE, Ruiz- Irastorza G, Gordon C, et al. Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine. Lupus Sci Med. 2022;9(1):e000789.