Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Nat Rev Rheumatol. 2018 Dec;14(12):693-703. doi: 10.1038/s41584-018-0111-8.
Despite advances in therapy for rheumatic diseases, hydroxychloroquine remains almost universally recommended for the treatment of systemic lupus erythematosus (SLE), and is often used in the management of other rheumatic diseases such as rheumatoid arthritis (RA). However, the major dose-limiting toxicity of hydroxychloroquine is retinopathy that can lead to loss of vision. New highly sensitive screening methods can identify early stages of retinopathy, and studies that include these modalities have indicated a substantially higher prevalence of hydroxychloroquine retinopathy than was previously recognized, resulting in revisions to ophthalmology guidelines and the recommendation of a low dose of hydroxychloroquine for many patients. However, the efficacy of low-dose hydroxychloroquine for treating SLE and other rheumatic diseases is unknown. Further studies are required to establish the effectiveness and retinal safety of the latest hydroxychloroquine treatment recommendations.
尽管风湿性疾病的治疗取得了进展，但羟氯喹仍然几乎普遍被推荐用于治疗系统性红斑狼疮（SLE），并且经常用于类风湿关节炎（RA）等其他风湿性疾病的治疗。然而，羟氯喹的主要剂量限制毒性是视网膜病变，可导致视力丧失。新的高灵敏度筛查方法可以识别视网膜病变的早期阶段，并且包括这些方法的研究表明，羟氯喹视网膜病变的患病率远高于以前认识到的，导致眼科指南的修订和建议许多患者使用低剂量羟氯喹。然而，低剂量羟氯喹治疗 SLE 和其他风湿性疾病的疗效尚不清楚。需要进一步的研究来确定最新的羟氯喹治疗建议的有效性和视网膜安全性。
