Keratopathy with low dose chloroquine therapy

Area of Science:

• Ophthalmology
• Rheumatology
• Pharmacology

Background:

• Antimalarial drugs, specifically 4-aminoguinolines, are frequently prescribed for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
• These medications are utilized for their anti-inflammatory properties and ability to induce remission in autoimmune conditions.
• Ocular toxicity is a known potential side effect of long-term antimalarial use.

Purpose of the Study:

• To investigate the ocular signs of toxicity in patients with RA and SLE treated with aminoquinoline antimalarial drugs.
• To assess the prevalence and characteristics of ocular side effects, specifically keratopathy and maculopathy.

Main Methods:

• A cohort of 39 patients (31 with RA, 8 with SLE) treated with chloroquine or hydroxychloroquine was examined for ocular signs.
• Patients received specific dosages: chloroquine 250 mg q.h.s. or hydroxychloroquine 200 mg b.i.d.
• Ocular examinations focused on detecting maculopathy and various degrees of keratopathy.

Main Results:

• No cases of maculopathy were detected in any of the patients.
• A significant majority, 75% of the patients, exhibited varying degrees of keratopathy.
• Observed keratopathy ranged from mild epithelial haze to dense "whorl" deposits.
• No correlation was established between the severity of keratopathy and the cumulative dose of aminoquinoline administered.

Conclusions:

• Aminoquinoline antimalarial therapy in RA and SLE patients is associated with a high incidence of keratopathy.
• Keratopathy, characterized by corneal deposits, is a more common ocular finding than maculopathy in this patient group.
• The development of keratopathy does not appear to be dose-dependent based on total drug administration.