Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Hydroxychloroquine Retinopathy in Inflammatory Arthritis: A Retrospective Analysis in Canadian Patients.
Osman1, Mohammed, Burnett1, Heather, Kydd2, Alison, Davis1, Paul, Rudnisky1, Christopher, Tennant1, Matthew, Yacyshyn1, Elaine
Antimalarial agents, hydroxychloroquine (HCQ, Plaquenil®) and chloroquine (CQ, Aralen®) have been linked to toxic ocular changes after prolonged use. The incidence of toxic changes is unclear for patients with inflammatory conditions, although prior studies show a low incidence (0.83.4%). In this study, we examined the frequency of true HCQ retinopathy in patients treated for various inflammatory conditions, with an abnormal mfERG.
Sixty-eight patients (age range 26 90 years) treated with HCQ between 2004 and 2010 were identified in this qualitative retrospective study. Patients with potential retinopathy were identified after having an abnormal multifocal electroretinogram (mfERG). Follow-up serial mfERG and complete ophthalmic assessments (visual acuity, dilated fundoscopy, automated Humphrey visual field (HVF)) were conducted to distinguish patients with HCQ retinopathy, as opposed to other conditions contributing to an abnormal mfERG. Repeated measures were completed 6 months to one year apart.
Of the total number of patients identified with an abnormal mfERG, four female patients (age range 5972 years) were identified with probable retinal toxicity (approximately 5.88 %) after 2.2, 4, 6 and 8 years of treatment with HCQ (mean dose 400 mg/d). None of these patients had ocular symptoms, although one of them had cataracts. Both patients using HCQ for more than 5 years developed Bull's eye maculopathy and had an abnormal HVF, while the other two were identified with serial mfERG and ophthalmic assessments. In addition, twenty-nine patients (age range 3690 years) were found to have a persistently abnormal mfERG with no evidence of toxicity (approximately 42.6 %). Twenty-two patients had other ocular diseases (glaucoma, macular degeneration, diabetic retinopathy, cataracts, retinal pigment epithelial changes), and diabetes or hypertension (17 patients). Seventeen patients (age range 2975 years) initially thought to have potential retinopathy were shown to have no evidence of antimalarial retinopathy after subsequent clinical and mfERG assessments.
We report a much higher rate of true postive abnormal mfERG than previously described in this select population of patients treated with HCQ. Of the sixty-eight patients, none of the patients with ocular toxicity were symptomatic and one of them developed ocular disease after only 2.2 years of treatment. Patients who have risk factors for potential toxicity, including duration of HCQ use, age, and other ocular diseases may benefit from mfERG screening, even in the absence of ocular symptoms. Our study highlights the important role mfERG may play in the early detection of patients at risk for developing antimalarial toxicity.
To cite this abstract, please use the following information:
Osman, Mohammed, Burnett, Heather, Kydd, Alison, Davis, Paul, Rudnisky, Christopher, Tennant, Matthew, et al; Hydroxychloroquine Retinopathy in Inflammatory Arthritis: A Retrospective Analysis in Canadian Patients. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2067