Chloroquine Retinopathy in Patients with Rheumatoid Arthritis

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Abstract
Consecutive patients (270) with rheumatoid arthritis who had received chloroquine therapy were examined ophthalmologically for toxic retinal lesions. The total annual dose of chloroquine was 70-75 g with the maximum total dose of 1330 g. The duration of treatment ranged up to 15 yr. The primary material was divided into 4 groups according to total chloroquine dose received: > 100 g, 101-300 g, 301-600 g and < 600 g. Each dose group was arbitrarily split into 2 age groups, one with patients under 63 yr of age and the other with patients over 63, in order to analyze the effect of age upon the ocular findings. Slight macular changes were included in the concept of maculopathy and were not thought to contraindicate chloroquine therapy. Macular changes were found in about 25% of the patients, regardless of age in the lowest dosage group. The frequency of maculopathy increased with increasing total dose only in the older age group. The frequency of maculopathies and other eye diseases also increased with increasing age, being evident even from the age of 50. The only patient with chloroquine retinopathy was an inadequately controlled 74 yr old woman. Chloroquine treatment of rheumatoid arthritis in the absence of any other disease which may cause retinopathy implies negligible risks in adult patients under 50 yr of age. These patients could be less frequently checked. Older patients require regular ophthalmological checks. It is important to use the smallest effective dose possible, and never higher than 4 mg of chloroquine phosphate/kg body weight daily for 10 mo. each year; in elderly patients, lower doses are preferred.

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