Researchers in England recently analyzed the efficacy of hydroxychloroquine in alleviating the pain associated with hand osteoarthritis. The data helps determine whether hydroxychloroquine is an appropriate medication option in managing hand osteoarthritis.
Hand osteoarthritis is characterized by inflammation of the joints of the hand. It is a debilitating disease that causes pain and loss of function. The symptoms of this condition reduce the patient’s quality of life because routine daily activities, such as writing, cooking and holding objects, become increasingly difficult to complete.
Treatment of hand osteoarthritis primarily consists of pain management with medications such as acetaminophen, ibuprofen, and capsaicin cream. Hydroxychloroquine is a medication regularly used in treating rheumatoid arthritis (inflammation in the joints caused by the immune system attacking the body). There is, however, insufficient data regarding its use in treating hand osteoarthritis.
A research news article published in the British Medical Journal reviewed the results of a study conducted by Sarah Kingsbury and her team in the United Kingdom. The goal of the study was to determine the effectiveness of hydroxychloroquine in managing the pain associated with hand osteoarthritis. There were 248 participants recruited from thirteen primary and secondary care centers in England. The participants were randomly placed in either a hydroxychloroquine group (200mg-400mg) or a placebo group. The outcomes measured include hand pain, grip strength, function, and quality of life.
At six months, the researchers did not find a significant difference in hand pain between the two groups. There was also no significant difference in grip strength, function or quality of life. One of the limitations noted in the article is that the hydroxychloroquine dosing calculation used in the study is less than the starting dose recommended in initiating rheumatoid arthritis therapy. A maximum dose of 6.5mg/kg per day, as recommended by the British National Formulary, was administered to the participants and most of the patients received 300mg daily.
The results of the study do not support the use of hydroxychloroquine in the treatment of pain due to hand osteoarthritis. The limitations of the study may be contributing factors to the development of this conclusion. More research in the treatment options of hand osteoarthritis will be valuable in improving the quality of life of patients with this health condition.
Written by Anuolu Bank-Oni, PharmD, CDE, BCGP
(1) Wise, J. Hydroxychloroquine should not be used for hand osteoarthritis, say researchers. BMJ 2018;360:k774 doi: 10.1136/bmj.k774
(2) Kingsbury SR, Tharmanathan P, Adamson J, et al. Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis (HERO): study protocol for a randomized controlled trial. Trials. 2013;14:64. doi:10.1186/1745-6215-14-64.