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ACR and Three Societies Agree on HCQ Eye Safety

MedPage Today

Four major medical societies issued a joint statement of principles on safe use of hydroxychloroquine from the perspective of ocular toxicity.

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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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Epi study of Scleritis in the UK (1997-2018) shows incidence declined from 4.23 to 2.79/100K persons/yr. Scleritis pts have 2 fold incr risk of IMIDs- esp GPA, Behçets Sjögrens, ReA, RA, SLE, Crohns, SLE & AS (OR 51 to >3). https://t.co/FzaCLRvmEX https://t.co/98M5o66fpD

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Dr. John Cush RheumNow ( View Tweet)
ACR and Three Societies Agree on HCQ Eye Safety Four major medical societies issued a joint statement of principles on safe use of hydroxychloroquine from the perspective of ocular toxicity. https://t.co/3ALK3MpOen https://t.co/SzScNXgoqn

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Dr. John Cush RheumNow ( View Tweet)
Dry Eyes and Tripping Over Tires RWCS 2021 Poster Session by Dr. Faizan Ahmad https://t.co/9UymYbYcJ0

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Dr. John Cush RheumNow ( View Tweet)

UTSW Rheum Grand Rounds - IgG4 Dz commonly presents as major salivary and lacrimal gland enlargement, orbital disease, autoimmune pancreatitis, retroperitoneal (mass) fibrosis or tubulointerstitial nephritis. @UTSWIMchief

Dr. John Cush RheumNow ( View Tweet)

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)

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