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. Can plaquenil cause w Hydroxychloroquine reactive arthritis Nov 01, 2015 H ydroxychloroquine HCQ; Plaquenil, Sanofi, Bridgewater, NJ is an antimalarial agent that is also commonly used as a treatment for a variety of rheumatologic and dermatologic conditions, such as rheumatoid arthritis and systemic lupus erythematosus. The most common side effect associated with its use is retinal toxicity, which may be irreversible. Apr 20, 2011 Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Of bull’s eye maculopathy developed as a result of chronic use of chloroquine. Case report A 51-year-old woman from Mainland China presented with a history of progressive deterioration in vision in both eyes for 6 months. Her medical history included severe rheumatoid arthritis, for which she had received chloroquine therapy for approximately 10 years. 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. Chloroquine bull's eye maculopathy guidelines Bull's-eye maculopathy - American Academy of Ophthalmology, New Plaquenil Guidelines - Mucinex and plaquenil Later in the disease, patients can develop a bilateral bull's eye maculopathy, characterized by a ring of retinal pigment epithelium RPE depigmentation in the macula, sparing the fovea, which is often accompanied by paracentral and central scotomas. End stage hydroxychloroquine toxicity leads to widespread RPE and retinal atrophy with a loss of central vision, peripheral vision, and night vision. Hydroxychloroquine Plaquenil Toxicity and Recommendations.. Chloroquine-induced bull’s eye maculopathy. Bulls Eye Maculopathy Chloroquine - Retina Image Bank. Revised guidelines recommend19 • Baseline examination within first year of usage of Plaquenil Hydrochloroquine or Aralen Chloroquine • Annual screening after 5 years of use **Interesting, The Royal College of Ophthalmologists in Great Britain does NOT recommend routine screening for toxicity with antimalarial drug use The American Academy of Ophthalmology released an updated set of screening recommendations for hydroxychloroquine Plaquenil and chloroquine to account for the many studies that have shown the effects of these medications on the retina 1. It succinctly makes the case for screening, and These findings were consistent with bull's eye maculopathy, a classic feature of advanced hydroxychloroquine toxicity. 3 months after medication was stopped, the patient's visual acuity had remained stable, and no other complaints were reported.