Chloroquine: Ophthalmological Safety, and Clinical Assessment in Rheumatoid Arthritis

In vivopriming of T cells against cryptic determinants by dendritic cells exposed to interleukin 6 and native antigen

“…Our results point to IL-6 as a major pharmacological mediator of altered antigen processing in vivo and are consistent with the hypothesis that autoreactive T cells can be engaged to induce and propagate autoimmune disease as a result of imbalanced signals to dendritic cells. If this hypothesis proves to be correct, blocking antigen processing by dendritic cells exposed to IL-6 by using safe acidotropic drugs may ameliorate autoimmune disease; in fact chloroquine, although it has some undesired side effects, has been used to treat rheumatoid arthritis with some success (56).…”

Value of Red Targets and Pattern Deviation Plots in Visual Field Screening for Hydroxychloroquine Retinopathy

“…However, some laboratories routinely use automated visual fields with a red test object, and older literature has suggested that red testing may be more sensitive in certain circumstances. [2][3][4] One may ask whether the recommendation for white visual field testing should be broadened to include the use of red testing as an alternative.…”

Early hydroxychloroquine macular toxicity

“…Although, in contrast to accepted evidence regarding chloroquine, a causal association of HCQ with maculopathy is viewed with skepticism by some (8), it is likely that HCQ caused the maculopathy in this case, which is indistinguishable from the many cases linked with chloroquine (9). While retinal pigmentary degeneration lacking a bull's-eye pattern is seen with similar frequency in patients with collagen disease whether or not they take antimalarial agents (10), bull's-eye maculopathy occurring outside the setting of 4-aminoquinoline use, although reported, is unusual (11).…”

“…Although pericentral scotomata on visual field testing are generally recognized as the most sensitive indicator of antimalarial-associated retinopathy (9,13,(19)(20)(21), and although isolated visual field defects usually prove to be reversible upon drug discontinuation (9,22), visual field testing is not routinely performed by all ophthalmologists (12) and was not performed by the ophthalmologist to whom this patient reported her initial symptoms. One commonly used visual field test, the Amsler grid, offers the convenience of home testing and can be done at no cost to the patient.…”

“…Although early 4-aminoquinoline-associated maculopathy is often asymptomatic (9,19), otherwise unexplained symptoms suggestive of chloroquine or HCQ ocular toxicity, such as difficulty reading because of missing letters or words, photophobia, and light flashes or streaks, should always precipitate immediate visual field testing. Although such symptoms often occur late in the course of 4-aminoquinoline-associated retinopathy (9) and may not improve upon drug discontinuation (5,27), there have been reports of symptom regression with antimalarial cessation (6,22,28,29).…”