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Keratoderma Blennorrhagicum — SCE Rheumatology MCQ

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HardSpondyloarthropathyKeratoderma BlennorrhagicumSCE Rheumatology

A 62-year-old with SLE has taken hydroxychloroquine 300 mg daily for 5 years. eGFR is 48 mL/min/1.73 m² and there are no visual symptoms. What monitoring is now appropriate in the UK?

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Correct answer: C — Arrange annual SD-OCT and fundus autofluorescence, recognising renal impairment as higher risk

Explanation lettering: D = shown as C · E = shown as D · C = shown as E

D is correct. RCOphth recommends annual monitoring after 5 years for all hydroxychloroquine users, with earlier surveillance for additional risk factors such as renal impairment; the core tests are SD-OCT and fundus autofluorescence. A misses presymptomatic toxicity. B uses an inadequate historical screen. C mistakes monitoring duration for a stop rule. E can assess adherence but cannot diagnose retinal structural injury.

Reference: Royal College of Ophthalmologists hydroxychloroquine retinopathy monitoring guideline 2020: https://www.rcophth.ac.uk/resources-listing/2609/