When filling prescriptions for hydroxychloroquine for rheumatoid arthritis, systemic lupus erythematosus or juvenile idiopathic arthritis, rheumatology nurses should coordinate with their patients’ ophthalmologists and be direct about the information they need regarding possible eye-related adverse effects, according to presenters at the Rheumatology Nurses Society Annual Conference.
“Ophthalmology, especially in the past 2 years, has called on rheumatology to say we are giving too much hydroxychloroquine,” Denise Smith-Hauser, NP-C, of the Cleveland Clinic, told attendees. “So, typically we would say, if you weigh less than 100 lb, you get one pill per day, and if you are more than 100 lb, you get two pills per day. There is a formula to calculate the dose, and that’s what ophthalmology does. The concern is that ophthalmologists need to do the visual field exam — it needs to say that there is no [hydroxychloroquine] toxicity.”
One way to strongly encourage patients to see an ophthalmologist for an eye exam, according to Smith-Hauser, is to fill their prescription for only 3 months — to provide enough time for the patient to seek out and receive the exam — and then not at all until the eye exam is completed.
“Once the patient does get the eye exam, I fill the prescription for a year,” she added. “I’m not mean, but with these medications, I will only fill it for 3 months, because if you fill it for a year before receiving the tests you need, you will never see that patient again. You will never have blood tests again, when they should be getting this test regularly.”
Vickie L. Sayles, BSN, CRNI, RN-BC, of the Cleveland Clinic Foundation, also added during the discussion that rheumatology nurses should be clear with their patients’ ophthalmologists that they require regular visual field tests, typically once per year.
“You also should educate the patient on what they need from their physician or ophthalmologist — it is a great opportunity to educate them,” Sayles said. “You need to ask the patient, ‘Did they make you chase the light around? That is what you need for the field test.’ A lot of the time, the patient does not know what to ask, but by being direct with both the ophthalmologist and the patient, we can improve that.” – by Jason Laday
Sayles SL. Current treatment guidelines and therapies. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 8-11, 2018; Fort Worth, Texas.
Disclosure: Smith-Hauser reports speaking fees from AbbVie, Amgen, Novartis and BMS, as well as consulting fees from AbbVie, Amgen and Novartis. Sayles reports speaking fees from Kevzara and Sanofi Genzyme.