Rheumatology Vol. 43 No. 8 © British Society for Rheumatology 2004; all rights reserved
Letter to the Editor |
Guidelines for the monitoring of hydroxychloroquine: reply
Rheumatology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester and 1 Staffordshire Rheumatology Centre, Haywood Hospital, Stoke on Trent, UK
Correspondence to: A. Samanta. E-mail: ash.samanta{at}uhl-tr.nhs.uk
We read with interest the responses by Mabrikakis et al. and Bernatsky to our article on the monitoring of ocular toxicity of hydroxychloroquine. We would like to raise two specific issues.
First, there are differences between the recommendations regarding monitoring for ocular toxicity of hydroxychloroquine between the British guidelines, the guidelines of the American College of Rheumatology, the Canadian Rheumatology guidelines, and the guidelines suggested by the American Academy of Ophthalmology. There is a need for harmonization of these guidelines by putting all the available evidence together and deciding what is best practice. Until this is done, variations in clinical practice will continue to exist.
Second, until there is consensus regarding monitoring, individual clinicians must be mindful of the recommendations made by bodies that may have influence within the geographical areas of their practice. This would be particularly relevant in the event of medical litigation. Studies from North America [1] have shown that clinical guidelines do play a small but important part in medical litigation. If this trend is followed in the UK, then it is likely that guidelines from the Royal College of Ophthalmologists would be engaged in determining the expected standard of care in cases of alleged negligence.
There is no doubt that a single consensus statement in this area would help clinicians to develop a more uniform pattern for the monitoring of hydroxychloroquine toxicity. However, we believe that reasons for non-adherence to guidelines may be multifactorial and that there is be a need to consider other ways to close, or at least narrow, the gap between evidence-based statements and actual clinical practice.
The authors have declared no conflicts of interest.
References
- Hyams A, Brandenberg J, Lipsitz S, Shaperio D, Brennan T. Practice guidelines and malpractice litigation: a two way street. Ann Intern Med 1995;122:450–5.
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