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Hydroxychloroquine Retinopathy — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyHydroxychloroquine RetinopathySCE Rheumatology

A 40-year-old woman with RA has been on Hydroxychloroquine 400 mg daily for 8 years (she weighs 55 kg). She develops subtle paracentral scotomata on visual field testing. OCT shows parafoveal thinning of the outer retinal layers. What is the diagnosis and management?

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Correct answer: B — Hydroxychloroquine retinopathy; stop Hydroxychloroquine immediately

At 55 kg, her actual Hydroxychloroquine dose exceeds the EULAR 2023 recommended target of 5 mg/kg/day (275 mg/day for her weight). She has been on a relatively high dose for 8 years, exceeding the cumulative risk threshold. Paracentral scotomata and outer retinal thinning on OCT represent early Hydroxychloroquine retinopathy. Hydroxychloroquine must be stopped immediately to prevent further irreversible retinal damage. Once established, retinopathy may progress even after drug withdrawal. This case highlights the importance of weight-based dosing.

Reference: RCOphth 2020 HCQ retinopathy screening guideline; EULAR 2023 SLE recommendations