Hydroxychloroquine is used in the management of rheumatoid arthritis and systemic/discoid lupus erythematosus. It is pharmacologically very similar to chloroquine which is used to treat certain types of malaria.

Adverse effects

• bull's eye retinopathy - may result in severe and permanent visual loss
  • recent data suggest that retinopathy caused by hydroxychloroquine is more common than previously thought and the most recent RCOphth guidelines (March 2018) suggest colour retinal photography and spectral domain optical coherence tomography scanning of the macula
  • baseline ophthalmological examination and annual screening is generally recommened

A contrast to many drugs used in rheumatology, hydroxychloroquine may be used if needed in pregnant women.

Monitoring

• the BNF advises: 'Ask patient about visual symptoms and monitor visual acuity annually using the standard reading chart'