Hydroxychloroquine-induced retinal toxicity in an asymptomatic patient

Hydroxychloroquine-induced retinal toxicity in an asymptomatic patient Mandela Thyoka et al. Alliance Registry. Arthritis Care Res (Hoboken) 21 Lundberg IE, Miller FW, Tjarnlund A, Bottai M. Diagnosis 2014;66:40410. and classification of idiopathic inflammatory myopathies. J Intern Med 2016;280:3951. 24 Pitt AM, Fleckenstein JL, Greenlee RG Jr et al. MRI-guided biopsy in inflammatory myopathy: initial results. Magn 22 Gowdie PJ, Allen RC, Kornberg AJ, Akikusa JD. Clinical Reson Imaging 1993;11:10939. features and disease course of patients with juvenile dermatomyositis. Int J Rheum Dis 2013;16:5617. 25 Hernandez RJ, Keim DR, Sullivan DB, Chenevert TL, Martel W. Magnetic resonance imaging appearance of the 23 Robinson AB, Hoeltzel MF, Wahezi DM et al. Clinical characteristics of children with juvenile dermatomyositis: muscles in childhood dermatomyositis. J Pediatr the Childhood Arthritis and Rheumatology Research 1990;117:54650. Rheumatology 2018;57:1668 doi:10.1093/rheumatology/key085 Clinical vignette Advance Access publication 2 April 2018 Hydroxychloroquine-induced retinal toxicity in an FIG.1 Investigation findings from this patient demon- asymptomatic patient strating classical features of HCQ-induced retinal toxicity A 68-year-old female treated with HCQ for SS for 15 years was referred for ophthalmic assessment after a high cu- mulative dose was identified (>1500 g on varying doses over time, 200400 mg daily). She had no visual symptoms but had been identified as being at risk of retinal toxicity due to the length of time on treatment and the significant cumulative dose received. On review, visual acuity was the following: right eye 6/7.5, left eye 6/12. Further inves- tigation demonstrated classical findings of HCQ toxicity [1] (Fig. 1). HCQ-induced retinal toxicity is more common than previ- ously thought [2]. The new British Society for Rheumatology/ British Health Professionals in Rheumatology guidelines recommend formal ophthalmic investigation at baseline and at annual intervals in patients receiving treatment beyond 5 years. This should take the form of retinal imaging techniques to include spectrum domain OCT as traditional methods including Amsler charts are not sufficient [2]. This will have implications for service provision. Updated guid- ance from the Royal College of Ophthalmologists is currently in consultation phase. (A) Bulls eye maculopathy on fundal photography; Funding: No specific funding was received from any (B) autofluorescence showing paracentral uptake; bodies in the public, commercial or not-for-profit sectors (C) spectrum OCT demonstrating loss of the paracentral to carry out the work described in this manuscript. retinal layers (flying saucer sign). Disclosure statement: The authors have declared no conflicts of interest. 1 2 2 Andrew Allard , Rachel Healy , Elizabeth Bristow References and Sarah Hickey 1 Marmor M. Comparsion of screening procedures in 1 2 Department of Rheumatology and Department of Ophthalmology, hydroxychloroquine retinopathy. Arch Ophthalmol Gloucestershire Royal Hospitals NHS Foudnation Trust, Gloucester, UK 2012;130:4619. 2 Marmour M, Kellner U, Lai T et al. American Academy of Correspondence to: Andrew Allard, Royal National Hospital Ophthalmology Statement; Recommendations on for Rheumatic Diseases, Upper Borough Walls, Bath Screening for Chloroquine and Hydroxychloroquine BA1 1RL, UK. Retinopathy (2016 Revision). Ophthalmology E-mail: andrew.allard@nhs.net 2016;123:138694. ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com 1668 https://academic.oup.com/rheumatology Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/9/1668/4958704 by Ed 'DeepDyve' Gillespie user on 28 August 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

Hydroxychloroquine-induced retinal toxicity in an asymptomatic patient

Rheumatology , Volume 57 (9) – Sep 1, 2018
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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com
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1462-0324
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1462-0332
D.O.I.
10.1093/rheumatology/key085
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Abstract

Mandela Thyoka et al. Alliance Registry. Arthritis Care Res (Hoboken) 21 Lundberg IE, Miller FW, Tjarnlund A, Bottai M. Diagnosis 2014;66:40410. and classification of idiopathic inflammatory myopathies. J Intern Med 2016;280:3951. 24 Pitt AM, Fleckenstein JL, Greenlee RG Jr et al. MRI-guided biopsy in inflammatory myopathy: initial results. Magn 22 Gowdie PJ, Allen RC, Kornberg AJ, Akikusa JD. Clinical Reson Imaging 1993;11:10939. features and disease course of patients with juvenile dermatomyositis. Int J Rheum Dis 2013;16:5617. 25 Hernandez RJ, Keim DR, Sullivan DB, Chenevert TL, Martel W. Magnetic resonance imaging appearance of the 23 Robinson AB, Hoeltzel MF, Wahezi DM et al. Clinical characteristics of children with juvenile dermatomyositis: muscles in childhood dermatomyositis. J Pediatr the Childhood Arthritis and Rheumatology Research 1990;117:54650. Rheumatology 2018;57:1668 doi:10.1093/rheumatology/key085 Clinical vignette Advance Access publication 2 April 2018 Hydroxychloroquine-induced retinal toxicity in an FIG.1 Investigation findings from this patient demon- asymptomatic patient strating classical features of HCQ-induced retinal toxicity A 68-year-old female treated with HCQ for SS for 15 years was referred for ophthalmic assessment after a high cu- mulative dose was identified (>1500 g on varying doses over time, 200400 mg daily). She had no visual symptoms but had been identified as being at risk of retinal toxicity due to the length of time on treatment and the significant cumulative dose received. On review, visual acuity was the following: right eye 6/7.5, left eye 6/12. Further inves- tigation demonstrated classical findings of HCQ toxicity [1] (Fig. 1). HCQ-induced retinal toxicity is more common than previ- ously thought [2]. The new British Society for Rheumatology/ British Health Professionals in Rheumatology guidelines recommend formal ophthalmic investigation at baseline and at annual intervals in patients receiving treatment beyond 5 years. This should take the form of retinal imaging techniques to include spectrum domain OCT as traditional methods including Amsler charts are not sufficient [2]. This will have implications for service provision. Updated guid- ance from the Royal College of Ophthalmologists is currently in consultation phase. (A) Bulls eye maculopathy on fundal photography; Funding: No specific funding was received from any (B) autofluorescence showing paracentral uptake; bodies in the public, commercial or not-for-profit sectors (C) spectrum OCT demonstrating loss of the paracentral to carry out the work described in this manuscript. retinal layers (flying saucer sign). Disclosure statement: The authors have declared no conflicts of interest. 1 2 2 Andrew Allard , Rachel Healy , Elizabeth Bristow References and Sarah Hickey 1 Marmor M. Comparsion of screening procedures in 1 2 Department of Rheumatology and Department of Ophthalmology, hydroxychloroquine retinopathy. Arch Ophthalmol Gloucestershire Royal Hospitals NHS Foudnation Trust, Gloucester, UK 2012;130:4619. 2 Marmour M, Kellner U, Lai T et al. American Academy of Correspondence to: Andrew Allard, Royal National Hospital Ophthalmology Statement; Recommendations on for Rheumatic Diseases, Upper Borough Walls, Bath Screening for Chloroquine and Hydroxychloroquine BA1 1RL, UK. Retinopathy (2016 Revision). Ophthalmology E-mail: andrew.allard@nhs.net 2016;123:138694. ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com 1668 https://academic.oup.com/rheumatology Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/9/1668/4958704 by Ed 'DeepDyve' Gillespie user on 28 August 2018

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RheumatologyOxford University Press

Published: Sep 1, 2018

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