LAUSR

Background Hydroxychloroquine (HCQ) is a medication commonly used to treat rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and other rheumatological conditions. A known adverse effect associated with long-term use of these medications is vision loss resulting from irreversible retinal toxic effects. Recent guidelines emphasized on routine ophthalmological examination and to adhere on real weight-based dosages. Objectives This audit conducted to evaluate adherence rate on standard recommendation on HCQ related retinopathy screening in rheumatology patients in St Vincent’s University Hospital (SVUH). Methods Patient were on HCQ and attended rheumatology clinics at SVUH with rheumatic diseases selected randomly from on 01/08/2017 and end on 01/04/2018. A total sample size of 56 patients received a questionnaire that included information on HCQ dose, duration and actual body weight. Other information included precipitant factors and ophthalmology examination reports were retrieved retrospectively form patient’s chart. Standards were measured against recommendations on screening for HCQ retinopathy published by American Academy of Ophthalmology, 2016 Revision. Results Total 56 patients on HCQ with different rheumatic disease studied. Out of 56 patients studied, 6/56 (10.7%) were <25 years (young), 45/56 (80.4%) were 25-65 years (middle age), and 5/56 (8.9%) were >65 years (elderly). Sex distribution showed that 7/56 (12.5%) were males and 49/56 (87.5%) were females. Around 35.7% (20/56) were in HCQ dose >5mg/kg, and 64.3% (36/56) were on standard HCQ dose (<=5mg/kg of real body weight. The were 44.6% (25/54) patients on HCQ for a period <5 years, the rest, 55.4% (32/56) were on HCQ for a period of 5-20years, and none of these patients were on it for >20 years duration. There were only 1/56 (1.8%) patient with history of HCQ toxicity, 98.2% (55/56) showed no history of HCQ related toxicity. None of the 56 patients had any of the following influencing factors: renal impairment, Tamoxifen usage, coagulopathies, hepatic impairment, or pre-existing retinal/macular disease. However, there were 8.9% (5/56) of this group their age was > 65years (verses 51/56 91.1% were <65years age. Only 69.6% (39/56) of these patients underwent retinal baseline screening, were 17/56 (30.4%) did not receive any baseline screening after commencing HCQ therapy. Frequency of follow up retinal screening were done annually in 19/56 (33.9%), 5 yearly in 6/56 (10.7%). However, it was not done in 21/56 (37%) and it was not due in 9/56 (16.1%). Out of those who underwent the screening at any time, 32/56 (57.1%) showed normal examination results, only 1/56 patient (1.8%) showed abnormal results. Rest of the patient data either were not available, or examination were not done. Conclusion Above data emphases the need to adhere on standards HCQ retinal screening as baseline and follow up. Furthermore, adherence on real weight calculated dose rather than estimated/average body weight. References [1] -Michael F. Marmor, Ulrich Kellner, Timothy Y.Y. Lai, et al. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology. 2017 Mar;124(3):e28-e29. Disclosure of Interests None declared