Hydroxychloroquine for treatment of rheumatoid arthritis: multifocal electroretinogram and laser flare-cell photometry study

Abstract

PurposeTo evaluate early changes in multifocal electroretinogram (mfERG) and subclinical aqueous humor flare and cellularity in patients receiving hydroxychloroquine (HCQ) as treatment for rheumatoid arthritis.MethodsTen patients receiving treatment with HCQ and no ophthalmic symptoms were enrolled. After complete ocular examination, mfERG and laser flare-cell photometry were performed. Patients were also divided into two subgroups with HCQ cumulative dose (CD) higher or lower than 500 g. Results obtained were compared with a control group of ten healthy subjects and statistical analysis was performed.ResultsIn patients receiving HCQ treatment, mfERG P1-wave in ring 2 showed a significant reduction in amplitude and a significant increase in latency compared to healthy control subjects, respectively resulting in 1.143 μV vs 1.316 μV (P=0.040) and 38.611 ms vs 36.334 ms (P=0.024). These changes are highly related to CD. Furthermore, when using the laser flare-cell photometry, a significant increase in aqueous humor flare and cellularity was shown in patients with CD higher than 500 g, resulting in a mean value of 14.4 ph/ms compared to 8.1 ph/ms in patients with CD lower than 500 g (P=0.0029). These reports appear highly related to CD (P=0.001). Receiver operating characteristic curve analysis showed mfERG P1-wave amplitude in ring 2 as the most sensitive value in detecting early HCQ-related retinopathy.ConclusionMfERG was shown to be a very sensitive test in detecting early retinal toxicity and should be used for the screening of patients receiving HCQ treatment. Although less sensitive, laser flare-cell photometry can provide further information to evaluate early toxic retinal cell damage.

Safety management in treatment with antimalarials in rheumatology. Interdisciplinary recommendations on the basis of a systematic literature review

“…The ophthalmological examinations (basic and check-up) should comprise at least one appropriate subjective and one objective method respectively apart from a fundus examination with imaging. Appropriate methods are automated perimetry tests (10 degrees in diameter, 2 degrees of distance = 10-2; for patients of Asian origin 24-2 or 30-2) as subjective methods [12,13] and OCT [13][14][15][16][17][18] [13,[19][20][21] or fundus autofluorescence (FAF) [22] as objective methods. The authors believe the OCT to be the most available objective method that will be used most frequently in practice.…”

The role of microbiome in rheumatoid arthritis treatment

“…Hydroxychloroquine (HCQ) is an antimalarial drug also used to treat RA because of its anti-inflammatory activity. 84 It reduces arthritis pain, joint swelling and may prevent the risk of long-term disability. It is known to interfere with the processing of auto-antigens by increasing lysosomal pH and reducing antigen processing and peptide loading in MHC class II proteins, resulting in decreased proliferation of CD4+ T cells and reduction in the release of cytokines.…”

Sicherheitsmanagement der Therapie mit Antimalariamitteln: was bedeuten die neuen Empfehlungen für die Praxis?

“…optische Kohärenztomografie (OCT) [13][14][15][16][17][18][19][20][21][22][23]. Die aGF sollte stan dardmäßig mit 10 Grad Durchmesser, 2 Grad Prüfabstand = 10-2 durchgeführt werden, bei asiatischen Patienten sind z.T.…”