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Systemic lupus erythematosus — USMLE Step 3 MCQ

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HardInternal Medicine (Chronic Management)Systemic lupus erythematosusUSMLE Step 3

A 60-kg woman with SLE has taken hydroxychloroquine 400 mg daily for 6 years. Disease is controlled, but she now has stage 3 CKD; baseline retinal testing was normal and she has had no subsequent screening. What is the best plan?

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Correct answer: E — Reduce to 300 mg daily and begin annual retinal screening now

The best answer is “Reduce to 300 mg daily and begin annual retinal screening now”. Her current dose is 6.7 mg/kg/day, above the recommended ceiling, and both duration beyond 5 years and CKD increase retinal-toxicity risk. Dose reduction preserves the flare- and damage-reduction benefit while annual sensitive retinal screening is arranged; abrupt substitution with chronic glucocorticoid creates greater long-term harm.

Reference: FDA Prescribing Information: Hydroxychloroquine Sulfate: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b4dca05a-745f-4c15-b731-1e99176cf44c