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Best of 2020: The Nine Lives of Hydroxychloroquine (Updated)

Martin J. Bergman, MD

Hydroxychloroquine is one of many medications frequently used in rheumatology practice. Its remarkable versatility is attested by its routine use in lupus, in patients with an autoimmune coagulopathy, in patients with rheumatoid arthritis, as well as in those with a low-level inflammatory arthropathy.

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ICYMI: The Nine Lives of Hydroxychloroquine (Updated)

Martin J. Bergman, MD

Hydroxychloroquine is one of many medications frequently used in rheumatology practice. Its remarkable versatility is attested by its routine use in lupus, in patients with an autoimmune coagulopathy, in patients with rheumatoid arthritis, as well as in those with a low-level inflammatory arthropathy.

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Antimalarials and Retinopathy: Dr. Janet Pope ( @Janetbirdope) #ACR20 https://t.co/6XqWxK8lCM https://t.co/YpDsEudGup

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Dr. John Cush RheumNow ( View Tweet)
#UTSW Rheum Grand Rounds on Sarcoidosis w/ Dr. HSIA - Joints are involved in 15% of pts. Lung sking and ocular involvement predominate https://t.co/G4iWm4pLmO
Dr. John Cush RheumNow ( View Tweet)
New video! Risk of HCQ Retinopathy: Dr. Kathryn Dao ( @KDAO2011) #ACR20 https://t.co/7BCVvMOm0T https://t.co/DOW91SSi2u

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Dr. John Cush RheumNow ( View Tweet)
I am glad now that chloroquine is not available (permanent back order) in Canada as results of high retinal toxicity w chloroquine was sobering & changed my practice. I won’t use it long term @RheumNow #ACR20 @CRASCRRheum abstr#1825 https://t.co/1RQi41uV1B https://t.co/lc9za22Zw1

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Janet Pope Janetbirdope ( View Tweet)
Don’t forget to check the eyes. Dr Kolfenbach. Top secret and Pearls #ACR20 @RheumNow It’s also useful for dx #sjogren #sarcoidodis #Ig G4 https://t.co/dxmwuwrPqz
Sole RetamozoSole ( View Tweet)
5yr DESIR cohort data estimated incidence rate of uveitis at 1.3/100p-y; over five years, uveitis was associated w/ dactylitis, biologic and sacroiliac MRI inflammation. #ABS1304 #ACR20 @RheumNow https://t.co/qmXlY7PmBB

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Dr. Rachel Tate uptoTate ( View Tweet)

@RheumNow #acr20 abs1306 CBP highly prevalent in anterior uveitis. 53%of uveitis pts complain of CBP. 23% eventually diagnosed/meet Dx criteria for AxPsA. 87%had already had CBP w/ previous episodes of uveitis. Men more likely to be clinically diagnosed ( 33%M vs13%F). https://t.co/2y0NxJOFRp
Olga Petryna DrPetryna ( View Tweet)
Mayo study found incidence of HCQ retinopathy w/ <5 mg/kg/d 5 years = 0%, at 10 years = 2.5% (historically w/ 6.5 mg/kg/d 5 yr incidence 1%,10 years 2%, 20 years 20%) Based on this study, which dose of HCQ will you prescribe? Abstr#540 #ACR20 @rheumnow

k dao KDAO2011 ( View Tweet)

Population study of 11 million, shows incidence of OPTIC NEURITIS is 3.7 /100K Pt-Yrs. Strongest association with multiple sclerosis (MS) and weaker associations with Behçet disease, sarcoidosis, and Sjögren syndrome. https://t.co/LVw0fcq1F1

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Dr. John Cush RheumNow ( View Tweet)

Study from 3 NYC lupus clinics compares flare rates in older SLE stopping HCQ (n 26) vs continuing HCQ (N 32) with no difference in lupus flare rates (19 vs 16%). Reasons for stopping HCQ: retinal toxicity 42%, pt preference 35%, adverse effects 15% https://t.co/7cVZbfJK68

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Dr. John Cush RheumNow ( View Tweet)

45 yr adult male w/ Kawasaki-like multisystem inflammatory syndrome w/ COVID-19 infx: presented w/ 6d fever, sore throat, diarrhea, LN, BLE pain, conjunctivitis, tachycardia, ESR 120, CRP 546 mg/L, high Troponin; Rx and resolved w/ IVIG & TCZ https://t.co/cyRBJccKop

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Dr. John Cush RheumNow ( View Tweet)

African-Americans with Ank Spondylitis have worse disease compared to whites. Study of 10,990 AS patients shows AA to have high frequency of anterior uveitis, hypertension, diabetes, depression, and heart disease and higher ESR and CRP levels. https://t.co/YyLqlM85sD

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Dr. John Cush RheumNow ( View Tweet)

Tocilizumab may be effective in refractory ocular-, neuro-, vasculo-Behcet's. Study of 47 Behcet's pts Rx w/ TCZ - good at ocular (24/25), CNS (6/6), vascular (7/7) & amyloidosis(2/2) but less effective w/ oral/genital (8/21), skin (6/14) or joints (4/11) https://t.co/lKY8D706bi

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Dr. John Cush RheumNow ( View Tweet)

New genome wide association study on anterior uveitis. Heritability for uveitis is 0.7, much greater than axSpA. Includes great data on genetic risk scores @ARVOiovs @AberdeenEpi @hteraG_senoJ https://t.co/gsX39YfrbN https://t.co/e8qBpL5xwy

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Dr Philip Robinson philipcrobinson ( View Tweet)
#EULAR2020 OP0333: Could SLE itself be a risk factor for retinopathy (not just because of HCQ)? @Janetbirdope study of >600 pts noted retinopathy risk factors: 1. longer duration of antimalarials 2. any use of chloroquine 3. SLE (OR 16.1 CI 2.1-125) @RheumNow https://t.co/seAR42K1SU
k dao KDAO2011 ( View Tweet)
This Spanish study of 255 SpA pts found that acute unilateral anterior uveitis was the most common pattern, primarily in HLA B27+. NO difference in incidence between SEC and TNFi treated pts. #EULAR2020 @RheumNow Poster #THU0388 https://t.co/OMfG8atfE4
Dr. Rachel Tate uptoTate ( View Tweet)
Our study shows that HCQ retinopathy virtually never occurs in first 5 yrs, SLE has more risk than other diseases such as RA and chloroquine has a far higher risk of retinal toxicity OP0333 #EULAR2020 @RheumNow @CRASCRRheum @earlyarthritis https://t.co/ZzRy3po4yw

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Janet Pope Janetbirdope ( View Tweet)

Certolizumab Pegol: A Safe And Efficient Treatment In Patients With Uveitis During Pregnancy: Conclusion: CZP seems to be effective and safe in female patients with uveitis during pregnancy and neonates. Abstract AB1055 #EULAR2020 @RheumNow https://t.co/MzeZKBawTg

Dr Philip Robinson philipcrobinson ( View Tweet)
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