Forgotten Effect of Hydroxychloroquine in the Sjogren’s Syndrome: Ototoxicity

Year 2021, Volume: 74 Issue: 1, 125 - 129, 30.04.2021

Yuce İslamoglu , Muharrem Gerçeker

Abstract

Objectives: Sjogren’s syndrome is a chronic, autoimmune and inflammatory disease. Sensorineural hearing loss is reported in ear involvement but the cause of this hearing loss is not known yet. Hydroxychloroquine has been long known to have ototoxic effects and it is often used in Sjogren treatment. In our study, we tried to explain the correlation of hearing loss in Sjogren with hydroxychloroquine use.

Materials and Methods: A prospective control study was designed and Sjogren syndrome patients were divided into two. Group 1 consist of 20 patients with drug usage. Group 2 consist of 15 patients without drug usage. Pure tone audiometric examination was done to all patients. Results were analyzed.

Results: There was not any statistically significant difference between the groups for either ear at 250 Hz, 500 Hz, 1000 Hz and 2000 Hz in the audiograph (p>0.05). There was a statistically significant difference at 4000 Hz in the left ear and 8000 Hz in the right ear and at 10,000 Hz in both ears (p<0.05). There was not any statistical significance at 4000 Hz in the right ear and at 8000 Hz in the left ear (p>0.05).

Conclusion: Sensorineural hearing loss can occur particularly at high frequencies in the Sjogren’s syndrome. This can be related to the duration of the disease or maybe it can occur due to hydroxychloroquine that is commonly used in treatment and known to be ototoxic. In our study, it was found that this drug had an impact on hearing loss. As the drug can accelerate the hearing loss that is already anticipated, it can also be completely responsible for the hearing loss by itself.

Keywords

Hydroxychloroquine , Ototoxicity , Sjogren

Ethical Statement

Ethical approval was obtained from Ankara University Medical School Ethical Committee (number: 2014-12-21).

Supporting Institution

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Project Number

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Thanks

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Sjögren Sendromu’nda Hidroksiklorokinin Unutulan Etkisi: Ototoksisite

Abstract

Amaç: Sjögren sendromu kronik, otoimmün ve enflamatuvar bir hastalıktır. Sensörinöral işitme kaybı kulak tutulumu olarak bilinir, ancak sebebi henüz bilinmemektedir. Hidroksiklorokin uzun süredir Sjögren tedavisinde kullanılmaktadır ve ototoksik etkileri olduğu bilinmektedir. Çalışmamızda Sjögren’deki işitme kaybının hidroksiklorokin kullanımı ile korelasyonu açıklanmaya çalışılmıştır.

Gereç ve Yöntem: Prospektif bir çalışma planlandı ve Sjögren sendromlu hastalar iki gruba ayrıldı. Grup 1, 20 hastadan oluşmaktaydı ve bunlar ilaç tedavisi altında olan hastalardı. Grup 2, 15 hastadan oluşmaktaydı ve henüz hidroksiklorokin kullanmaya başlamamış hastalardan oluşmaktaydı. Tüm hastalara pure tone odyometri incelemesi yapılmış ve sonuçlar değerlendirilmiştir.

Bulgular: Odyografide her iki kulak için 250 Hz, 500 Hz, 1000 Hz ve 2000 Hz’de gruplar arasında istatistiksel olarak anlamlı bir fark yoktu (p>0,05). Sol kulakta 4000 Hz’de ve sağ kulakta 8000 Hz’de ve her iki kulakta 10.000 Hz’de anlamlı fark elde edildi (p>0,05). Sağda 4000 Hz’de ve solda 8000 Hz’de anlamlı fark elde edilmedi (p>0,05).

Sonuç: Sjögren sendromunda özellikle yüksek frekanslarda sensörinöral işitme kaybı görülebilir. İşitme kaybı hastalığın süresi ile ilişkili olabileceği gibi tedavisinde sıklıkla kullanılan ototoksik olduğu bilinen hidroksiklorokin sebebi ile olabilir. Çalışmamızda da ilacın bu hastalıkta işitme üzerinde etkisi olduğu tespit edilmiştir. Tedavide kullanılan ilaç işitme kaybını hızlandırıyor olabilir ya da işitme kaybının tek sebebi de olabilir.

Keywords

Hidroksiklorokin , Ototoksisite , Sjögren

Ethical Statement

Ethical approval was obtained from Ankara University Medical School Ethical Committee (number: 2014-12-21).

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. Harris ED. Approaches to the treatment of Sjögren Sendrome. In: Kelley WN, Harris ED, Ruddy S, Sledge CB eds. Textbook of Rheumatology, 4th Ed. Philadelphia: WB Saunders Company.; 1993; s. 1027-1037.
• 2. Colin G, Derrick A, Cohen D, et al. Clinical Rheumatology 4th Ed. Newyork: Churchill Livingstone.; 1986. s. 222.
• 3. Gálvez J, Sáiz E, López P, et al. Diagnostic evaluation and classification criteria in Sjögren’s Syndrome. Joint Bone Spine. 2009;76:44-49.
• 4. Whaley K, Alspaugh MA. Sjogren’s syndrome. In: Kelley WN, Harris ED, Ruddy S, Sledge CB eds. Textbook of Rheumatology, 4th Ed. Philadelphia: WB Saunders Company.; 1993; s. 999-1013.
• 5. Franquet T, Giménez A, Monill JM, et al. Primary Sjögren’s syndrome and associated lung disease: CT findings in 50 patients. AJR Am J Roentgenol. 1997;169:655-658. doi: 10.2214/ajr.169.3.9275871. PMID: 9275871.
• 6. Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554-558.
• 7. Gerceker M, Muz SE. Ototoxicity ve vestibulotoxicity. In: Gerçeker M. eds. Textbook Kulak Burun Boğaz ve Baş Boyun Cerrahisi. MN medikal ve Nobel tıp kitapevi; Ankara. 2013; s. 185-203.
• 8. Bortoli R, Santiago M. Chloroquine ototoxicity. Clin Rheumatol. 2007;26:1809-1810.
• 9. Sykes H. The ototoxicity of chloroquine sulphate in the guinea pig. Br J Audiol. 1984;18:59-69.
• 10. Johansen PB, Gran JT. Ototoxicity due to hydroxychloroquine: report of two cases. Clin Exp Rheumatol. 1998;16:472-474.
• 11. Mathews J, Kumar BN. Autoimmune Sensorineural Hearing Loss. Clin Otolaryngol Allied Sci. 2003;28:479-488.
• 12. Tucci M, Quatraro C, Silvestris F. Sjögren’s syndrome: an autoimmune disorder with otolaryngological involvement. Acta Otorhinolaryngol Ital. 2005;25:139-144.
• 13. Montoya-Aranda IM, Peñaloza-López YR, Gutiérrez-Tinajero DJ. Síndrome de Sjögren comportamiento clínico y audiológico en función de la edad [Sjögren’s syndrome: Audiological and clinical behaviour in terms of age]. Acta Otorrinolaringol Esp. 2010;61:332-337.
• 14. Ziavra N, Politi EN, Kastanioudakis I, et al. Hearing loss in Sjögren’s syndrome patients. A comparative study. Clin Exp Rheumatol. 2000;18:725-728.
• 15. Tumiati B, Casoli P, Parmeggiani A. Hearing loss in the Sjögren syndrome. Ann Intern Med. 1997;126:450-453.
• 16. Ziavra N, Politi EN, Kastanioudakis I, et al. Hearing loss in Sjögren’s syndrome patients. A comparative study. Clin Exp Rheumatol. 2000;18:725-728.
• 17. Hatzopoulos S, Amoroso C, Aimoni C, et al. Hearing loss evaluation of Sjögren’s syndrome using distortion product otoacoustic emissions. Acta Otolaryngol Suppl. 2002;(548):20-25.
• 18. Ding HJ, Denniston AK, Rao VK, et al. Hydroxychloroquine-related retinal toxicity. Rheumatology (Oxford). 2016;55:957-967.
• 19. Coutinho MB, Duarte I. Hydroxychloroquine ototoxicity in a child with idiopathic pulmonary haemosiderosis. Int J Pediatr Otorhinolaryngol. 2002;62:53-57.
• 20. Seçkin U, Ozoran K, Ikinciogullari A, et al. Hydroxychloroquine ototoxicity in a patient with rheumatoid arthritis. Rheumatol Int. 2000;19:203-204.
• 21. Lim SC, Tang SP. Hydroxychloroquine-induced ototoxicity in a child with systemic lupus erythematosus. Int J Rheum Dis. 2011;14:1-2.
• 22. Kabasakal Y, Kitapcioglu G, Turk T, et al. The prevalence of Sjögren’s syndrome in adult women. Scand J Rheumatol. 2006;35:379-383.
• 23. Çefle A, Yazıcı A, Turgut T. Primer Sjögren sendromu olan 25 hastanın klinik ve laboratuar bulgularının değerlendirilmesi. Tıp Araştırmaları Dergisi: 2010:8:22-26. https://docplayer.biz.tr/12932979-Tip-arastirmalari-dergisi- 2010-8-1-22-26-primer-sjogren-sendromu-olan-25-hastanin-klinik-velaboratuar- bulgularinin-degerlendirilmesi.html.