Hydroxychloroquine is an integral part of maintenance therapy in lupus patients. Recent UK guidelines recommend that patients on hydroxychloroquine need to have regular monitoring. The risk of retinal toxicity becomes significant after a cumulative dose of 1 gram or after 7 years of drug use. Monitoring with use of spectral domain optical coherence tomography (OCT) is required after 5 years of use from recent guidelines.
The University hospitals of Leicester which serves 1 million population has a diverse group of caucasian and black with minority ethnic (BME) groups. There are 293 patients with lupus on the rheumatology databse of the tertiary hospital. 194 (66%) of them are on hydroxychloroquine. We performed an audit of patients that have regular eye monitoring whilst on hydroxychloroquine. Letters were sent out to the patients with lupus on hydroxychloroquine. 106 responses were obtained with a response rate of 55%. 96 (91%) were female and the remainder were male. The average age of the respondents was 49 years. The average duartion of hydroxychloroquine use was 79 months. 53% of the respondents had been on Hydroxychloroquine for more than 5 years. 42% of all respondents were made of patients in the BME group. Of the 106 responders, only 86% (91) were aware that eye checks were required. Majority of the patients (60%) who were not aware of the need for regular eye monitoring were in the BME group. 71% of patients who had not had regular eye monitoring had other co-morbidities other than lupus. 1 in 5 of patients who did not have regular eye monitoring had other DMARDs alongside hydroxychloroquine. 20% of this patient cohort were not compliant with regular eye monitoring after use of hydroxychloroquine after 5 years or more.
Ethnicity, disease factors, use of other DMARDs and duration of hydroxychloroquine use may play a role in determing patient compliance with regular eye monitoring. We recommended that more should be done to continually educate patients about the need to have yearly eye checks.
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