Hydroxychloroquine Ineffective in Treating Hand Osteoarthritis Compared With Placebo

Hydroxychloroquine (HCQ) showed no signs of effectiveness when compared with a placebo with an indication to relieve moderate to severe hand pain and radiographic osteoarthritis, according to a randomized trial published in Annals of Internal Medicine.

Symptomatic hand osteoarthritis affects up to 31% of adults over 70 years old. The condition is characterized as chronic persistent pain and difficulty performing daily activities. HCQ is a commonly prescribed therapy to improve quality of life for osteoarthritis patients.

The Hydroxychloroquine Effectiveness in Reducing symptoms of hand Osteoarthritis (HERO) trial determined the effectiveness of HCQ in treating hand osteoarthritis as an analgesic treatment compared with a placebo.

The UK study involved 13 National Health Service hospitals.¹ Two hundred forty-eight patients with a mean age of 62.7 years who had symptoms of hand osteoarthritis were randomly assigned to treat their condition with either HCQ or a placebo. Data was collected at 3, 6, and 12 months. Questionnaires and ultrasounds were used to measure pain levels and grip strength of hand joints. The dosage amount was based on the size of the patient.

In both groups, hand pain severity improved around 1 point from baseline to 3 months. After 6 months, there was no difference in pain level or grip strength between the 2 cohorts.

Fifteen patients reported serious adverse events, with 7 from the HCQ cohort and 8 from the placebo cohort. Out of all the adverse events, 3 were related to HCQ, including ventricular arrhythmias, erythema multiforme, and acute generalized erythematous pustulosis.

The authors concluded that HCQ does not offer any benefit in relieving pain associated with hand osteoarthritis.

Researchers noted that only long-standing osteoarthritis patients were enrolled in the study. If newly diagnosed patients were included, the results could have been different.

In an editorial, Elena Losina, PhD from Brigham Women’s Hospital, and Jeffrey N. Katz, MD, MSc from Harvard Medical School, wrote, “Although HCQ is safe, it is also a weak anti-inflammatory agent seldom used in contemporary practice as a solo disease-modifying therapy for rheumatoid arthritis and other inflammatory conditions. Further therapeutic studies of the effects of anti-inflammatory therapy on nodal hand osteoarthritis will need to use more potent agents or compounds developed to more specifically target the inflammatory pathways documented in this condition.”²

References

1. Kingsbury SR, Tharmanathan P, Keding A, et al; Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis. Published online February 20, 2018. Ann Intern Med. doi:10.7326/M17-1430

2. Losina E, Katz JN. Hydroxychloroquine: Another battle lost in the campaign to find effective therapies for hand osteoarthritis. Published online February 20, 2018. Ann Intern Med. doi: 10.7326/M18-0035