Plaquenil, AMD, and Inflammatory Arthritis

I don’t believe patients with AMD should take hydroxycholoroquine sulfate or Plaquenil®. This drug is often used to treat people with severe arthritis or lupus erythematosis. Hydroxychloroquine accumulates in the Retinal Pigment Epithelium (RPE) and rarely causes vision loss with atrophy of the RPE and photoreceptors. With more sensitive testing however, we have found that some people on this drug appear to have damage to their retinal function yet still have excellent acuity and no symptoms. This may mean that this drug damages the retina (albeit slightly) in more patients than we suspected because we didn’t have sensitive enough tests. AMD affects the same layers, namely the RPE and photoreceptors, as hydroxychloroquine does. It may be harmful to use a drug that can damage the same cells that are struggling anyway in AMD. This can be a difficult decision for a doctor because hydroxycholoroquine is a very effective drug in many arthritic patients. If you have both arthritis and AMD, hopefully your doctor can find an alternative medicine to Plaquenil®. As a side note, there is a recent publication(1), that reported a lower incidence of AMD in patients with rheumatoid arthritis. The authors speculated that the lower incidence of AMD in the arthritis patients may have been due to the anti-inflammatory medicines they had been taking for many years to control their disease. This makes sense, the authors say, since there is new evidence that inflammation plays a role in AMD. This is interesting but preliminary information that will have to be confirmed in other studies. This article doesn’t dissuade me however, from recommending that someone with AMD should not take Plaquenil. There are other medicines that are more anti-inflammatory than Plaquenil and also effective to treat rheumatoid arthritis. Reference: 1. McGeer PL, Sibley J. “Sparing of age-related macular degeneration in rheumatoid arthritis.” Neurobiol Aging. 2005 Aug-Sep;26(8):1199-203.