In Sjögren’s, Plaquenil is used to treat many symptoms of Sjögren’s including fatigue, joint symptoms of arthritis and arthralgias (joint pain), dry mouth and dry eyes. Similar to its use in systemic lupus erythematosus, many clinicians feel that it is useful in reducing general Sjögren’s “disease activity.” One of the reasons that physicians feel comfortable in prescribing Plaquenil is its low risk to benefit ratio. Plaquenil screening recommendations Rates of plaquenil toxicity Aimovig plaquenil interaction Evaluation by visual field testing and/or spectral domain optical coherence tomography OCT showed the overall prevalence of retinal thinning and photoreceptor damage or visual field loss was 7.5%. The risk climbed with greater daily dosage and duration of therapy, reaching a prevalence of nearly 20% after 20 years on hydroxychloroquine JAMA. Several risk factors may increase the likelihood of retinal toxicity from Plaquenil such as, age of greater than 60 years, daily dose more than 6.5 mg/kg; use of the drug more than 5 years, obesity, preexisting retinal disease and, renal or liver failure. Toxicity cannot be prevented by screening, so the goal is early detection of changes in visual field or spotting parafoveal thinning on OCT before changes to the retinal pigment epithelium appear,” Dr. Marmor said. “If the drug is stopped before there is RPE damage, progression and central visual loss can be prevented,” he said. As with any medication, allergic reactions including skin rashes and non-allergic reactions can occur. This means that the side effects of Plaquenil are mild and infrequent compared with its potential benefits. Retinal thinning in plaquenil toxicity oct Selective thinning of the perifoveal inner retina as an., The Risk of Retinal Toxicity with Plaquenil - Sjogren's Plaquenil retinopathy autofluorescenceChloroquine vs doxycyclinePlaquenil and fluPlaquenil half-lifePlaquenil and allergy testing In a separate study designed to compare chronically treated patients with and without ophthalmoscopic evidence of toxicity, significant thinning of the inner, outer and full thickness retina was observed in patients with clinically apparent retinal toxicity, whereas only selective thinning of the inner retina was detected in the group without fundus changes. 13 Once again, RNFL thinning was absent in patients with chronic HCQ exposure and no fundus changes; however, the group with fundus. Multimodal Imaging in Plaquenil Toxicity. Drug Toxicity to the Retina and Optic Nerve Are You.. Retinal Physician - Hydroxychloroquine Maculopathy An.. SD-OCT scan from a 44-year-old woman with bilateral plaquenil toxicity. There is damage visible in the outer retina in a perifoveal distribution. Thinning of the photoreceptor layer, ellipsoid layer, outer nuclear layer, and RPE can be among the earliest signs of hydroxychloroquine toxicity. 4 These changes often occur in the parafoveal area, although they can be more peripheral in Asian patients. The presence of bull’s-eye maculopathy indicates the disease has been progressing for years, resulting in foveal thinning and likely vision loss. 8 SD-OCT is a highly sensitive and reproducible imaging modality used in the detection of Plaquenil retinal toxicity. The preferential loss of photoreceptor IS/OS junction makes SD-OCT an ideal tool to identify early changes associated with Plaquenil retinal toxicity.