Prevalence and Risk Factors for Hydroxychloroquine Retinopathy among Patients with Systemic Lupus Erythematosus

Abstract

Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with unclear etiology that affects multiple organs and affects mostly women of childbearing age. The skin, blood vessels, kidneys, central nervous system and joints are common targets of inflammation at onset or during the course of the disease. The development of SLE is attributed to disruptions in adaptive immunity, triggered by genetic predisposing factors and environmental triggers, which lead to the loss of tolerance to self-antigens. Aim of the Work: Early detection of patients treated with Hydroxychloroquine who develop retinal toxicity and the risk factors for the development of Hydroxychloroquine induced retinal toxicity among Systemic lupus erythematosus patients. Patients and Methods: The study is a cross-sectional observational study for assessment of the Prevalence and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus. A convenient sample of 80 systemic lupus erythematosus patients, satisfying at least four of the revised American college of rheumatology (ACR) criteria for SLE, was recruited from the outpatient clinic and inpatients at the department of internal medicine-Rheumatology division in Ain Shams university hospital from July 2018 to August 2019. Results: In the present study, there were a significant positive relation (P=0.003) between hydroxycholoroquine duration of therapy (8-10years) &abnormal FAF, a significant negative relation (pvalue =0.000)between best corrected visual acuity and abnormal FAF and a significant positive relation (pvalue=0.000)between number of patients having abnormal fundus and patients having abnormal FAF On the other hand, there were no significant relation proved with age, sex, clinical manifestations, SlEDAI score, laboratory data and immunological markers. Conclusion: These findings strongly suggest that the risk of HCQ retinopathy increased with the duration of therapy. Moreover, routine screening by fundus or FAF (More accurate & more sensitive) might help to optimize retinopathy.