Hydroxychloroquine and chloroquine: assessing the risk of retinal toxicity

BACKGROUND: During the past 10 years there has been an increase in the use of the antimalarial agents, chloroquine and hydroxychloroquine, in the treatment of various rheumatic diseases.

METHODS: In the United States, hydroxychloroquine (Plaquenil) is one of the most commonly prescribed medications for mild to moderately severe rheumatoid arthritis. Both chloroquine and hydroxychloroquine have the potential to produce an irreversible maculopathy. However, this maculopathy occurs almost exclusively at higher than recommended doses.

RESULTS: Careful dose monitoring by the rheumatologist, combined with appropriate ocular examination by the eye care professional, can significantly reduce the risk of retinopathy.

CONCLUSIONS: This paper discusses the use of chloroquine and hydroxychloroquine in the treatment of rheumatoid arthritis and systemic lupus erythematosus, it summarizes their retinotoxic risk, and it outlines the diagnostic techniques used to evaluate patients treated with these medications.