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Hydroxychloroquine retinopathy — SCE Rheumatology MCQ

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HardRheumatoid arthritisHydroxychloroquine retinopathySCE Rheumatology

A 46-year-old woman with rheumatoid arthritis taking hydroxychloroquine for six years reports difficulty reading at night. Visual acuity is preserved, but optical coherence tomography shows parafoveal ellipsoid-zone disruption. Her estimated glomerular filtration rate is 42 mL/min/1.73 m^2. What is the most appropriate management?

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Correct answer: D — Stop hydroxychloroquine and refer for ophthalmology-led monitoring

OCT changes in a patient on long-term hydroxychloroquine suggest retinal toxicity, and renal impairment increases risk. Visual acuity may remain preserved early, so reassuring based on acuity would be unsafe. Chloroquine has retinal toxicity risk and is not the solution.

Reference: Royal College of Ophthalmologists hydroxychloroquine monitoring; BNF