Hydroxychloroquine Not Effective in Hand Osteoarthritis

Pam Harrison

July 01, 2015

ROME — In patients with symptomatic osteoarthritis of the hand, 24 weeks of treatment with hydroxychloroquine did not ease pain or improve function, new research shows.

"Findings from our trial do not support the prescription of hydroxychloroquine for patients with mild to moderate pain from hand osteoarthritis, neither on a physical nor emotional level," Natalja Basoski, MD, from Maasstad Ziekenhuis in Rotterdam, the Netherlands, said in a statement.

"However, further investigations are needed to determine whether hydroxychloroquine relieves pain in other specific phenotypes of hand osteoarthritis," she added.

The results were presented here at the European League Against Rheumatism Congress 2015.

The study participants had primary hand osteoarthritis, were 40 years and older, and were recruited from rheumatology clinics in the Rotterdam region from July 2010 to December 2013. They were randomly assigned to oral hydroxychloroquine 400 mg/day for 24 weeks or to placebo.

Paracetamol (Tylenol) was used as a rescue medication.

The primary outcome was a decrease in hand pain in the previous 24 hours, rated on a visual analogue scale, after 24 weeks of treatment.

Secondary outcomes included pain at 6 and 12 weeks, change in total score on the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and score on the 10-point Arthritis Impact Measurement Scales 2 (AIMS2-SF) at the end of the study.

At baseline, median pain was similar in the hydroxychloroquine and placebo groups (45 vs 50 mm), as was mean AUSCAN score (5.2 vs 5.0) and mean AIMS2-SF score (3.7 vs 3.9).

After 24 weeks of treatment, the difference in median pain was not significantly different between the hydroxychloroquine and placebo groups (36 vs 48 mm).

In fact, there were no significant differences in pain scores, AUSCAN scores, or AIMS-SF2 scores between the two groups at any timepoint.

Table. Mean Difference in Outcome Measures from Baseline to 24 Weeks

Outcome Measure Hydroxychloroquine Group (n = 98) Placebo Group (n = 98) P Value
Pain, mm –1.300 0.100 .82
Total AUSCAN –0.420 –0.250 .49
Total AIMS2-SF –0.076 –0.170 .68

 

"Our study was the first randomized placebo-controlled trial to evaluate hydroxychloroquine in the treatment of symptomatic hand osteoarthritis," Dr Basoski told Medscape Medical News in an email.

"And while it was well tolerated, it was still associated with more allergic reactions and rash than placebo," she reported. "So our trial does not support the prescription of hydroxychloroquine in patients with mild to moderate symptoms of hand osteoarthritis."

Off-Label Use

"Hydroxychloroquine is sometimes used off-label to treat osteoarthritis of the hands in patients who fail standard therapies such as paracetamol, other analgesics, NSAIDs, and steroid injections," said Scott Zashin, MD, from the University of Texas Southwestern Medical Center in Dallas in an email to Medscape Medical News.

However, this study evaluated hydroxychloroquine in only one type of osteoarthritis that affects the hands, he cautioned.

"The authors made it clear that other types of osteoarthritis — for example, erosive osteoarthritis — may benefit from treatment with hydroxychloroquine, even though controlled studies are not available at this time to answer such a question," Dr Zashin explained.

Dr Basoski and Dr Zashin have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2015: Abstract OP0304. Presented June 13, 2015.

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