Correspondence

Re: Marmor et al.: American Academy of Ophthalmology Statement: Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 Revision). (Ophthalmology 2016;123:1386-1394)

The objective of this study is to describe the efficacy of hydroxychloroquine (HCQ) in patients with oral lichen planus (OLP) refractory to conventional therapy.

In this single-center retrospective study, patients were prescribed HCQ 200 mg twice daily. Pain, reticulation, erythema, and ulceration scores were recorded. Two-sample and paired t tests were used to evaluate mean and paired pain scores and paired t test to determine substantial differences in paired REU scores, at HCQ initiation visit and final follow-up at 12 to 24 months.

Thirty-six patients (69.4% female) with a median age of 70 ± 12.0 (range 48-99) were initiated on HCQ. Only 30 patients were evaluable because pruritus developed in 5 patients (13.9%) and gastrointestinal symptoms in 1 (2.8%). The mean follow-up was 23.2 months (range 1-74). In 19 patients, there was a significant decline in the worst pain score from a mean of 3.9 (SD± 2.8, n = 19) to 1.9 (SD ± 2.4, n = 19) (t = 2.837, P < .006). Paired reticulation, erythema, and ulceration (REU scores) decreased from a weighted mean score of 16.0 (SD ± 8.0, n = 12) to 12.0 (SD ± 6.3, n = 12) (t = 2.07, P < .032).

Hydroxychloroquine was a suitable option and effective in reducing symptoms and disease severity in patients with recalcitrant OLP who do not adequately respond to standard therapy.

Au cours de la maladie de Sjögren ou syndrome de Sjögren primitif (SSp), les patients peuvent présenter des atteintes hétérogènes. La triade symptomatique caractéristique incluant sécheresse, fatigue et douleur est fréquente. Trente à 40 % des patients peuvent développer des atteintes systémiques. Ainsi, le suivi des patients atteints de SSp est personnalisé et doit être adapté au phénotype clinique et biologique du patient. Les modalités et la fréquence du suivi dépendent notamment de la présence ou non de complications systémiques, ou de leur risque de survenue. Le SSp étant une pathologie rare, il est recommandé d’organiser cette prise en charge en collaboration avec un centre de référence. La prise en charge est multidisciplinaire, impliquant différents professionnels de santé en fonction des atteintes initiales et de l’évolution. Le suivi a pour objectif de préciser l’activité et la sévérité de la maladie, ainsi que de dépister l’apparition d’atteintes systémiques. Il évalue l’efficacité et la tolérance des traitements et recherche des comorbidités. De plus, les facteurs de risque de lymphome doivent être régulièrement réévalués. Un suivi régulier de l’atteinte ophtalmologique et de l’état buccodentaire est nécessaire. Les recommandations récemment établies par l’EULAR portent sur la prise en charge de la triade sécheresse, fatigue et douleur, et détaillent la prise en charge des atteintes systémiques. De plus, le Protocole National de Diagnostic et de Soins (PNDS), établi récemment, propose une stratégie claire pour le suivi des patients. Enfin, l’éducation thérapeutique constitue un pilier de la prise en charge, permettant aux patients d’être actifs dans la gestion de leur maladie.

In primary Sjögren's syndrome (pSS), patients may present with heterogeneous symptoms. The triad of characteristic symptoms is frequent and includes dryness, fatigue, and pain. Also, 30 to 40% of patients may develop systemic damage. Thus, pSS patients’ follow-up is individualized and must be adapted to the patient clinical and biological phenotype. The modalities and the frequency of the follow-up depend on the presence or not of systemic complications, or their risk factors. As pSS is a rare disease, it is recommended to organize its management in collaboration with reference centers. pSS management is multidisciplinary and involves different health professionals depending on the initial damage characteristics and the evolution. The aim of the follow-up is to determine the activity and severity of the disease, as well as to detect occurrence of systemic complications. It assesses the efficacy and tolerance of treatments and includes the search for comorbidities. In addition, risk factors of lymphoma must be regularly reassessed. Regular monitoring of ophthalmologic and oral status is required. Recent EULAR guidelines address the management of the triad of dryness, fatigue and pain, and detail the management of systemic involvement. In addition, the “Protocole National de Diagnostic et de Soins” has been recently established and presents a clear strategy for patient management and follow-up. Finally, therapeutic education is a pillar of pSS management, allowing patients to be active in their disease follow-up.