She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Plaquenil with pregnancy The doctor stop my plaquenil Rates and Predictors of Hydroxychloroquine Retinal Toxicity in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus FREDERICK WOLFE1 AND MICHAEL F. MARMOR2 Objective. Hydroxychloroquine HCQ retinopathy is of concern because of the potential seriousness of visual loss and the medicolegal consequences of failure to detect toxicity. The risk of ocular toxicity increases with the cumulative hydroxychloroquine dose. The prevalence of retinopathy in those using the drug less than 10 years is less than 2%; in contrast, the prevalence in patients with more than 20 years of exposure is reported to be as high as 20%. 26 The exact incidence and prevalence of HCQ-induced retinal toxicity is unknown. As the incidence and prevalence data on collagen vascular disorders such as SLE and RA are variable, it is difficult to calculate the exact risk of retinal toxicity among patients with RA and SLE who are treated with HCQ. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Hydroxychloroquine retinopathy prevalence Hydroxychloroquine Plaquenil Toxicity and., Hydroxychloroquine An old drug with new relevance. What is the difference between plaquenil and hydroxychloroquineDrugs for ra plaquenil and Purpose. To determine the prevalence of high-risk factors for hydroxychloroquine HCQ retinopathy and compliance with the American Academy of Ophthalmology AAO screening guidelines at the San Francisco Veterans Affairs Medical Center VASF and to develop an approach to improve the risk-benefit relationship and informed consent during HCQ treatment. IMPROVING THE RISK-BENEFIT. - PubMed Central PMC. Retinal Toxicity in Patients Treated With Hydroxychloroquine.. Monitoring for hydroxychloroquine retinopathy Eye. Results Real body weight predicted risk better than ideal body weight and was used for all calculations. The overall prevalence of hydroxychloroquine retinopathy was 7.5% but varied with daily consumption odds ratio, 5.67; 95% CI. The pattern of retinopathy caused by both HCQ and CQ is similar, but is much less common with HCQ. The earliest clinical changes in HCQ retinopathy are subtle changes at the macula, with pigmentary stippling and loss of the foveal reflex the typical light reflection seen on fundoscopy. Diagnosis Hydroxychloroquine-induced retinal toxicity Discussion. Chloroquine CQ and hydroxychloroquine Plaquenil HCQ have been used for many years, initially for the treatment of malaria but now more commonly for the treatment of inflammatory diseases such as rheumatoid arthritis and lupus 1.