Hydroxychloroquine vs Placebo for Patients With Osteoarthritis of the Hands

Treatment with hydroxychloroquine (HCQ) in patients with osteoarthritis (OA) of the hands is not significantly more effective than placebo in reducing symptoms, according to a multicenter, double-blind study published in Arthritis Care & Research.¹

Current symptomatic treatment of hand OA is limited because of potential adverse effects.^2,3 Only a few trials have demonstrated some beneficial effect of HCG in hand OA; however, these trials were of poor quality and the results were inconsistent.^4-6 Therefore, this was the first high-quality randomized controlled trial of HCQ for OA. The study included 196 patients with symptomatic hand OA who received either 400 mg HCQ once a day (n=98) or placebo (n=98).¹

At 24 weeks, the mean change from baseline in the 100-mm visual analog scale (VAS) for pain was −1.1 mm in the HCQ group and +1.1 mm in the placebo group, which was not significant (P =.45), as were the differences at 6 and 12 weeks.¹ Changes in the Australian Canadian Hand Osteoarthritis Index and the Arthritis Impact Measurement Scale 2 short form scores were minimal and there were no significant differences between the treatment groups. Adverse effects were similar in both treatment groups, with 5 patients in the placebo group and 10 patients in the HCQ group discontinuing the study because of adverse effects.

The authors concluded that, “the results of our study show that HCQ is not effective in reducing hand OA symptoms in the investigated population, thereby suggesting it should no longer be prescribed for all patients with hand OA. Further investigation is needed to identify specific patient populations with specific characteristics that might benefit from HCQ.”¹

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Reference

1. Lee W, Ruijgrok L, Boxma-de Klerk B, et al. Efficacy of hydroxychloroquine in hand osteoarthritis: a randomized, double blind, placebo-controlled trial [published online November 10, 2017]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23471
2. Kloppenburg M. Hand osteoarthritis-nonpharmacological and pharmacological treatments. Nat Rev Rheumatol. 2014;10:242-251.
3. Towheed TE. Systematic review of therapies for osteoarthritis of the hand. Osteoarthritis Cartilage. 2005;13:455-462.
4. Bryant LR, des Rosier KF, Carpenter MT. Hydroxychloroquine in the treatment of erosive osteoarthritis. J Rheumatol. 1995;22:1527-1531.
5. Robertson C, Rice J, Allen N. Treatment of erosive osteoarthritis with hydroxychloroquine. Osteoarthritis and Cartilage. 1992;1:64.
6. Punzi L, Bertazzolo N, Pianon M, Michelotto M, Todesco S. Soluble interleukin 2 receptors and treatment with hydroxychloroquine in erosive osteoarthritis. J Rheumatol. 1996;23:1477-1478.