What’s new in Rheumatology?

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The American Academy of Ophthalmology has issued revised recommendations for screening and prevention of hydroxychloroquine (HCQ) and chloroquine (CQ) retinopathy (1). The usual dose is (400 mg/day) for HCQ and 250 mg/day for CQ. Both require adjustment for ideal body weight in individuals who are short and overweight. In others no adjustment of dose is required. Automated visual field testing should be done at baseline and subsequent screening.

Nonsteroidal antiinflammatory drugs including the COX-2 selective NSAIDs and some nonselective NSAIDs, increase the risk of adverse cardiovascular events. NSAID use in patients with a prior MI is associated with a significantly increased risk of death or recurrent MI, compared with nonuse of NSAIDs, even within one to two weeks of beginning treatment, and risk remained elevated throughout the treatment course (2].

Among the nonselective NSAIDs, risk is greatest for diclofenac, and also increased for ibuprofen; the risk is least with naproxen. The absolute increase in the incidence of death or recurrent MI is one per 5000 person-years.

References
1. Marmor MF, Kellner U, Lai TY, et al. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology 2011;118:415.
2. Schjerning Olsen AM, Fosbøl EL, Lindhardsen J, et al. Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: A nationwide cohort study. Circulation 2011.