Rheum with a View

PERRLA

How many times do we write this or see this recorded or presented without really carefully examining the eye or the fundus? How many of us still look at the fundus? Most medical residents don’t even carry or own ophthalmoscopes and have little comfort with the exam of the eye or fundus. This leads me to the new recommendations regarding antimalarials. Recently, my college and medical school roommate, Marty Pearlman, MD, and his wife visited my wife and me. Marty went into ophthalmology and now does retinal surgery in Lansing, Michigan. Marty’s love for what he does is so infectious that two of his four children are also ophthalmologists; in fact, one of them specializes in the retina.

During our visit, Marty informed me that the American Academy of Ophthalmology (AAO) developed a new set of recommendations on screening for antimalarials.¹ I was unaware of this—and perhaps others are, too. Briefly, these are revisions of 2002 recommendations. This update was prompted by improved screening tools and data, suggesting that risk of drug toxicity increases toward 1% after five to seven years of use or a cumulative dose of 1,000 grams of hydroxychloroquine.

Recommendations are that a routine dosage of 400 mg hydroxychloroquine daily is acceptable for all, but for individuals of short stature (rather than dosing by weight), baseline evaluation should be carried out, annual screening should begin after five years unless there are unusual risks, and at least one of the newer tests—multifocal electroretinogram (mfERG), spectral domain optical coherence tomography, or fundus autofluorescence—should be used routinely. Additionally, mfERG may replace the visual field exam, Amsler grid testing is no longer needed, and fundus exams should be documented. (Editor’s Note: For more on the new AAO guidelines, see “Hydroxychloroquine Retinopathy Still Alive and Well” in the May 2011 issue of The Rheumatologist, p. 50, or online at www.the-rheumatologist.org/details/article/1066217/.html.)

Marty has done very well, and I couldn’t be happier for his success. I recall when I moved out of our shared apartment (I was getting married) that Marty and I had to split our stuff, most of which had little value. I lost the final coin flip, so he got the good rug, and I was left with the stethoscopic heart sounds record. So, he still owes me; maybe he can show me how to do some of those retinal tests.

What is contained in a tear?

There Will Never Be a Panush’s Syndrome

Nor will there be a Panush’s disease, or even Panush’s sign. My mom (may she rest in peace) would have been disappointed. We all were notified electronically about the recommendations of the ACR, the American Society of Nephrology, and European League Against Rheumatism to begin shifting away from eponyms.² This was prompted “by evidence that Dr. Friedrich Wegener was a member of the Nazi party before and during World War II,” according to the authors of the article, which was published in Arthritis & Rheumatism, Dr. Wegener may also have been complicit with war crimes.