Hydroxychloroquine dosing — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyHydroxychloroquine dosingSCE Rheumatology

A 68-year-old woman with SLE weighs 48 kg and takes hydroxychloroquine 400 mg daily. She has CKD stage 3 and has taken the drug for 8 years. Disease is quiescent. Ophthalmology reports early retinal toxicity changes. What is the most appropriate management?

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Correct answer: C — Stop or reduce hydroxychloroquine after urgent rheumatology-ophthalmology review

Explanation lettering: B = shown as A · A = shown as B

Stop or reduce hydroxychloroquine after urgent rheumatology-ophthalmology review is best because retinal toxicity requires urgent review and usually cessation or dose adjustment because progression can continue. A is less suitable because allopurinol is unrelated to SLE retinal toxicity; B is less suitable because increasing dose worsens toxicity risk; D is less suitable because chloroquine has greater retinal toxicity risk; E is less suitable because normal visual acuity does not exclude early maculopathy. Clinical pearl: hydroxychloroquine dose should be weight-adjusted and reviewed in renal impairment.

Reference: EULAR SLE recommendations 2023; RCOphth hydroxychloroquine monitoring guidance; BNF