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HCQ Retinopathy Risk Factors — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyHCQ Retinopathy Risk FactorsSCE Rheumatology

A 50-year-old man with RA on biologics develops progressive visual field defect. He has been on Hydroxychloroquine for 9 years at a dose of 400 mg daily weighing 65 kg. OCT shows parafoveal outer retinal thinning. What risk factors does he have for HCQ retinopathy?

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Correct answer: E — Duration >5 years dose exceeding 5 mg/kg/day (400/65 = 6.15 mg/kg) and duration of use all increase retinal toxicity risk

This patient has multiple risk factors for HCQ retinopathy: treatment duration >5 years (9 years) and dose exceeding the EULAR 2023 recommended target of 5 mg/kg/day (his actual dose is 6.15 mg/kg/day at 65 kg). Additional risk factors include renal impairment (reduces HCQ clearance) concurrent Tamoxifen use and pre-existing macular disease. RCOphth 2020 guidelines recommend dose reduction to ≤5 mg/kg/day and annual screening with OCT from year 5. The parafoveal thinning on OCT represents early toxicity that may progress even after drug withdrawal.

Reference: RCOphth 2020 HCQ screening; EULAR 2023 SLE recommendations