1. SF: in my clinic of 200 SLE patients, 25 -yrs, I have patients with definite HCQ retinopathy. The SD-OCT, VF 10-2, and mfERG have greatly helped us catch it early. Caveat: never take an ophth dx of "HCQ retinopathy" without a HCQ expert (Dr. Reshma Katira in DC) 2nd opinion. The changes are often due to other retina problems, pt can continue HCQ, but follow mfERG closely.
2. We all need to check HCQ levels q3mo. It should be the SOC (along with checking UPCR, antidsDNA, C3, C4, anti-C1q, EC4d). Aim for 1000ng/ml-1200 (less flares per Coastedau-Chalumeuax & less thrombotic events per Petri if >1000, less retinopathy if < 1200 per Petri). You will find many poorly adherent pts, let them know you are watching them like a hawk.. you will get better adherence & more of your pts will go into remission (even nephritis patients) or low LDA. You can adjust their dose more properly than the poorly- studied 5mg/kg AAO recs. I have pts on as much as 600mg/d (bariatric surg pts) &I have very heavy pts who only need 200mg qd (300-400 mg was too much). This is a new chapter in taking better care of SLE patients! Thanks RheumNow for having so many lupus articles to keep everyone up to date.
1. SF: in my clinic of 200 SLE patients, 25 -yrs, I have patients with definite HCQ retinopathy. The SD-OCT, VF 10-2, and mfERG have greatly helped us catch it early. Caveat: never take an ophth dx of "HCQ retinopathy" without a HCQ expert (Dr. Reshma Katira in DC) 2nd opinion. The changes are often due to other retina problems, pt can continue HCQ, but follow mfERG closely.
2. We all need to check HCQ levels q3mo. It should be the SOC (along with checking UPCR, antidsDNA, C3, C4, anti-C1q, EC4d). Aim for 1000ng/ml-1200 (less flares per Coastedau-Chalumeuax & less thrombotic events per Petri if >1000, less retinopathy if < 1200 per Petri). You will find many poorly adherent pts, let them know you are watching them like a hawk.. you will get better adherence & more of your pts will go into remission (even nephritis patients) or low LDA. You can adjust their dose more properly than the poorly- studied 5mg/kg AAO recs. I have pts on as much as 600mg/d (bariatric surg pts) &I have very heavy pts who only need 200mg qd (300-400 mg was too much). This is a new chapter in taking better care of SLE patients! Thanks RheumNow for having so many lupus articles to keep everyone up to date.