부산대학교 도서관

Background: Hydroxychloroquine(HQ) is widely used to treat for rheumatoid arthritis( RA) and connectice tissue disorders. Due to the potential of ocular toxicity,routine ophtalmological assessment(ROA) is essential for sight safety. Methods: In our outpatient clinic, patients with RA and connective tissue disorders such as systemic lupus erythematosus (SLE), sjogren syndorme (SS) and overlap were assessed consecutively for drug status of HQ by a standard questionnaire between December 2013 and January 2014. Patients who used HQ less than 1 year (13. 6%) were excluded from study. Ocular toxicity was taken from patients` reported. If ophthalmologist advised to cease HQ due to ocular toxicity,we accepted as ocular side effect. Patients with ocular toxicity were not reevaluated by an ophthalmologist. Cumulative HQ dosage and risk factors for ocular toxicity were assessed by using Mann-Whitney U test. Results: A total of 266 patients(90. 6% female) were enrolled. Mean age was 50±13. 5 years and median disease duration was 8 years(1-50). Median duration of HQ treatment was 6 years(1-28) and median dose was 400 mg/day. Of 46(17. 3%) patients were ceased HQ. The reasons of cease of HQ were ocular toxicity 22(47. 8%), patient non-adherence 9(19. 6%),dermatological side effect 3(6. 5%),others 12(26. 1%). 22 of all 266(%8. 3) patients developed ocular toxicity. Ocular toxicity was found more frequently in male 5/20(20%) vs 17/241(7%),p=0. 025). Median cumulative HQ dosage in patients with ocular toxicity was 864 gram (108-2160) in other words 12. 9 gr per kilogram( 1. 2-40). Older age (58±10 vs 50±13,p=0. 008),longer disease duration (14. 8±11. 5 vs 9. 2±7. 1 years,p=0. 013), and longer HQ duration (10±6. 3 vs 7. 1±5. 6 years,p=0. 023)were associated with ocular toxicity. Conclusions: Among regularly follow-up patients, ocular toxicity of HQ was not rare in a rheumatology outpatient clinic. Cumulative toxicity for ocular toxicity was 13 gram/kilogram;however, certain patients developed toxicity in 1 gram/kg/day. Although, important part of our patients was female, ocular toxicity was seen more frequently in male patients. Other risk factors such as longer disease duration,longer HQ usage and older age were also demonstrated in our patients.