Assessment of Hydroxychloroquine Retinal Toxicity in Systemic Lupus Erythematosus in Arab Emirati Patients

Abstract

Hydroxychloroquine (HCQ) has a central role for long-term treatment in all lupus patients. Given the broad spectrum of beneficial effects, HCQ is given to most patients with lupus during the whole course of the disease, irrespective of its severity. The most concerning potential toxicity of HCQ is the risk of retinopathy.We screened between 2017 and 2021, 124 Arab Emirati lupus patients on HCQ for retinal toxicity and compared them to 171 healthy Emirati controls. Out of the 124 initial patients, 60 attended for a second screening visit, 18 for a third and 3 for the 4th (average 573 days between the first and the last visit).We were the first to establish a proper screening program in the United Arab Emirates. HCQ retinal toxicity in Arab Emirati patients is very low (less than 1%) in keeping with internationally reported figures. We found that OCT is the best choice as initial screening test and should be carried out in all patients. In case of doubt multi focal electro retinogram is recommended. Adherence of lupus patients to the yearly follow up screening visit was poor (48%). Physicians and patients¿ education are essential to improve early detection of HCQ retinal toxicity.