“That is why it is recommended that we go by ideal body weight, or IBW-taking into account lean body mass more so than any extra fat mass in people who are overweight.” “Plaquenil is not deposited into fat,” he explains. “I think people with lupus can make a difference by pointing out the new guidelines to their rheumatologists,” he says.
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Thomas is enthusiastic about the updated guidelines, although he worries that the new dosing recommendations have not been widely disseminated to rheumatologists. New dosing guidelines for Plaquenil, which Lyons worked on, were published in the journal Ophthalmology. We just need to get better at monitoring the eyes and dosing Plaquenil correctly.” “But you can’t even compare it to the only other things I have -prednisone, where 100 percent of people get side effects, or immunosuppressive drugs, suppress the immune system, potentially causing infections, low blood counts, and liver toxicity. Thomas says he understands people’s concerns about the drug’s potential for toxicity. “They also are less likely to develop major organ involvement.” “We know that people with lupus who take their Plaquenil regularly are much more likely to live a long, normal life compared with those who don’t,” he says. Thomas Jr., MD, FACR, FACP, a practicing rheumatologist in Greenbelt, Md., and author of The Lupus Encyclopedia, regularly prescribes Plaquenil to his lupus patients. Encourage them to talk about any changes.” New Plaquenil dosing guidelines increase safetyĭonald E. Lyons’ advice to rheumatologists: “When taking patient histories, ask about symptoms affecting their vision. Any change in vision-whatever you perceive as different from normal-should be checked out.” Lyons’ advice to patients: “The earliest true signs would be kind of a shimmering light, so-called ‘photopsias,’ which often are in a circular pattern. In doing those tests once a year we should be able to prevent progression of retinal damage.” “Rarely will anybody who has good vision and minimal symptoms develop loss of central vision or ability to read if annual screening is done and visual are symptoms reported as soon as they occur so the medication can be stopped if toxicity occurs. “Eye damage due to Plaquenil is not common,” he says. Plaquenil-induced toxicity usually will not occur before five years of taking the drug.
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Lyons emphasizes the importance of annual screening and says that, although annual screening is recommended for everyone taking Plaquenil, it is imperative for people who have been taking the medication for more than 10 years, who have a higher incidence of retinal toxicity. Ophthalmologist and medical retina specialist Jonathan Lyons, MD, who practices in Silver Spring, Md., and teaches at MedStar Washington Hospital Center and MedStar Georgetown University Hospital, both in Washington, DC, has long been involved in developing the standards for what ophthalmologists should look for during vision screenings. Improved vision screening tests and updated dosing guidelines are key to avoiding such complications.
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While side effects of corticosteroids are usually to blame, there is also the possibility of ocular damage associated with long-term use of the antimalarial drugs hydroxychloroquine (brand name: Plaquenil®) and chloroquine. But take this advice: Don’t ignore changes in vision. With all of the physical and emotional complications that lupus can cause, it’s easy to overlook symptoms that seem minor at first.