Does Hydroxychloroquine Improve Symptoms of Hand Osteoarthritis?

Findings do not support the current practice of off-label use of hydroxychloroquine for treating symptomatic hand osteoarthritis.

For patients with moderate to severe hand pain and radiographic osteoarthritis, hydroxychloroquine was found to be no more effective than placebo for relieving pain. Findings from this study were published in the Annals of Internal Medicine.

While not officially approved to treat hand osteoarthritis, hydroxychloroquine is used in many countries as a treatment for patients who have failed prior therapies. For this randomized, double-blind, placebo-controlled study (HERO), researchers sought to determine the effectiveness of hydroxychloroquine as an analgesic treatment in patients with symptomatic hand osteoarthritis who had inadequate response to other therapies (ie, non-steroidal anti-inflammatory drugs, opioids).

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The study was conducted in 13 primary and secondary care centers; study patients had had hand pain for a median of 5 years. Patients were administered hydroxychloroquine 200–400mg daily or placebo for 12 months. The primary endpoint was overall hand pain severity (measured on a 0–10 numerical rating scale) over the previous 2 weeks at 6 months; secondary endpoints included self-reported pain and function, grip strength, quality of life, radiographic structural change, and adverse events.

The results showed that at 6 months, hydroxychloroquine was not more effective than placebo for reducing hand pain (mean hand pain:  5.66 points for hydroxychloroquine group vs 5.49 points for placebo group; treatment difference: –0.16 point; 95% CI, –0.73 to 0.40 point; P=0.57). With regard to the secondary outcomes, no significant differences were seen at 3, 6, or 12 months. Moreover, baseline structural damage or synovitis was not linked to treatment effect.

The authors concluded that the findings of their study do not support the current practice of off-label use of hydroxychloroquine in patients with hand osteoarthritis.

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