Cardiac manifestations in patients with systemic lupus erythematosus and rheumatoid arthritis: Relation to long-term use of hydroxychloroquine

Aim of the work

to investigate and record cardiac side effects of long-term use of hydroxychloroquine (HCQ) in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).

Patients and methods

This study included 25 patients with RA and 25 with SLE. The study population was either in remission or demonstrated low disease activity, as assessed by the SLE disease activity index 2000 (SLEDAI-2 K) for SLE patients and the disease activity score 28 (DAS28) for RA patients. All patients had been receiving HCQ for at least two years. They did not exhibit any symptoms of coronavirus disease-2019 (COVID-19) and received COVID-19 vaccination. Cardiac adverse events were assessed through electrocardiogram (ECG) and echocardiography (ECHO) examinations.

Results

94 % (n = 47) were females and 6 % (n = 3) were males. The age of the subjects ranged from 20 to 60 years, with a mean age of 41.6 ± 11.2 years. Out of the 50 ECGs assessed, 84 % (n = 42) exhibited no abnormalities. Additionally, all ECGs showed QTc within the normal range. Only 2 RA patients had heart failure characterized by reduced ejection fraction (EF). There was no significant association between the cumulative dosage of HCQ administered in SLE patients and the ECG abnormalities (p = 0.76), QTc (p = 0.228) or EF (p = 0.96). Moreover, there was no significant association between the cumulative dosage of HCQ administered in RA patients and the ECG abnormalities (p = 0.479), QTc (p = 0.85) or EF (p = 0.69).

Conclusion

This study affirms the cardiac tolerability of HCQ in the sustained therapeutic management of SLA and RA patients.