• Sarah R Kingsbury, Puvan Tharmanathan, Ada Keding, Sarah J Ronaldson, Andrew Grainger, Richard J Wakefield, Catherine Arundel, Fraser Birrell, Michael Doherty, Tonia Vincent, Fiona E Watt, Krysia Dziedzic, Terence W O'Neill, Nigel K Arden, David L Scott, John Dickson, Toby Garrood, Michael Green, Ajit Menon, Tom Sheeran, David Torgerson, and Philip G Conaghan.
• Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, United Kingdom (S.R.K., A.G., R.J.W., P.G.C.).
• Ann. Intern. Med. 2018 Mar 20; 168 (6): 385395385-395.

BackgroundSynovitis is believed to play a role in producing symptoms in persons with hand osteoarthritis, but data on slow-acting anti-inflammatory treatments are sparse.ObjectiveTo determine the effectiveness of hydroxychloroquine versus placebo as an analgesic treatment of hand osteoarthritis.DesignRandomized, double-blind, placebo-controlled clinical trial with 12-month follow-up. (ISRCTN registry number: ISRCTN91859104).Setting13 primary and secondary care centers in England.ParticipantsOf 316 patients screened, 248 participants (82% women; mean age, 62.7 years) with symptomatic (pain ≥4 on a 0- to 10-point visual analogue scale) and radiographic hand osteoarthritis were randomly assigned and 210 (84.7%) completed the 6-month primary end point.InterventionHydroxychloroquine (200 to 400 mg) or placebo (1:1) for 12 months with ongoing usual care.MeasurementsThe primary end point was average hand pain during the previous 2 weeks (on a 0- to 10-point numerical rating scale [NRS]) at 6 months. Secondary end points included self-reported pain and function, grip strength, quality of life, radiographic structural change, and adverse events. Baseline ultrasonography was done.ResultsAt 6 months, mean hand pain was 5.49 points in the placebo group and 5.66 points in the hydroxychloroquine group, with a treatment difference of -0.16 point (95% CI, -0.73 to 0.40 point) (P = 0.57). Results were robust to adjustments for adherence, missing data, and use of rescue medication. No significant treatment differences existed at 3, 6, or 12 months for any secondary outcomes. The percentage of participants with at least 1 joint with synovitis was 94% (134 of 143) on grayscale ultrasonography and 59% on power Doppler. Baseline structural damage or synovitis did not affect treatment response. Fifteen serious adverse events were reported (7 in the hydroxychloroquine group [3 defined as possibly related] and 8 in the placebo group).LimitationHydroxychloroquine dosage restrictions may have reduced efficacy.ConclusionHydroxychloroquine was no more effective than placebo for pain relief in patients with moderate to severe hand pain and radiographic osteoarthritis.Primary Funding SourceArthritis Research UK.

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