HCQ Screening High Risk — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeHCQ Screening High RiskSCE Rheumatology

A 38-year-old woman with SLE and positive anti-Ro antibodies is referred to ophthalmology for Hydroxychloroquine screening. Her eGFR is 42 mL/min. According to RCOphth when should her screening begin?

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Correct answer: E — Early OCT and visual-field screening

RCOphth 2020 guidelines recommend baseline ophthalmological assessment within the first year of HCQ use for ALL patients then annual screening from year 5. However patients with additional risk factors should have earlier annual screening (from year 1). Risk factors include: renal impairment (eGFR <60 reduces HCQ clearance increasing drug accumulation) concurrent Tamoxifen use (competitive protein binding) HCQ dose >5 mg/kg/day and pre-existing macular disease. This patient with eGFR 42 should have annual screening from year 1 not year 5. HCQ dose should also be adjusted for her body weight and renal function.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions