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The antimalarial drug hydroxychloroquine (HCQ) is used to manage many rheumatic diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The main long-term risk associated with this drug is retinal toxicity. Known risk factors include higher dose, longer duration of use, cumulative dose of more than 1000 g, older age, renal or hepatic dysfunction, and obesity. Although retinal toxicity previously was considered to be rare, more recent studies have shown that it might occur in as many as 20% of patients who use HCQ for 20 years. This led the American Academy of Ophthalmology to suggest a maximal daily dose of no greater than 5 mg/kg.
Researchers evaluated 537 SLE patients from a Johns Hopkins registry to assess wh…