[Early electroretinografic changes in elderly RA patients treated with hydroxychloroquine]

Area of Science:

• Ophthalmology
• Rheumatology
• Pharmacology

Background:

• Hydroxychloroquine is commonly used for Rheumatoid Arthritis (RA).
• Hydroxychloroquine can cause retinal toxicity, necessitating early detection.
• Ophthalmological monitoring is crucial for patients on long-term hydroxychloroquine therapy.

Purpose of the Study:

• To assess the efficacy of fundoscopy, electrooculography, electroretinogram (ERG), and visually evoked potentials (VEPs) in the early detection of hydroxychloroquine-induced retinal toxicity in RA patients.
• To investigate the influence of patient age, drug dosage, and concomitant therapies (prednisone, methotrexate) on the development of this side effect.

Main Methods:

• 32 RA patients initiating hydroxychloroquine treatment were enrolled.
• Regular ophthalmological examinations including fundoscopy, electrooculography, ERG, and VEPs were performed every 4 months.
• Disease activity and serum creatinine levels were monitored regularly.

Main Results:

• No retinopathy was observed in any patient within the 1-year follow-up period.
• Fundoscopy, electrooculography, and VEPs showed no significant changes from baseline.
• Electroretinogram revealed early alterations in scotopic and photopic responses. A significant correlation was found between age (>65 years) and increased photopic b1 wave amplitude (p < 0.05).
• No correlation was identified between ERG alterations and hydroxychloroquine dosage, concomitant medications, or serum creatinine levels.

Conclusions:

• Fundoscopy, electrooculography, and VEPs are not effective for the early detection of hydroxychloroquine retinopathy.
• Electroretinogram is a valuable tool for the early identification of retinal changes associated with hydroxychloroquine treatment, particularly in patients older than 65 years.