HCQ Not Effective for Mild/Moderate Hand OA

The lupus drug hydroxychloroquine (HCQ), which is sometimes tried off-label for the relief of osteoarthritis (OA) of the hand, appears not to be effective, at least for mild to moderate cases.

A200-patient randomized trial coordinated by a team at Leiden University in the Netherlands tested a daily 400-mg dose of HCQ for 24 weeks against placebo among patients who had primary hand OA according to American College of Rheumatology criteria.

There were no significant differences in the primary outcome (self-reported pain on a 0-100 visual analogue scale) at any point during the trial, and improvements in two secondary outcomes, the Arthritis Impact Measurement (AIM) scale and the Australian Canadian Hand Osteoarthritis Index (AUSCAN) were similar for the drug and placebo. More patients taking HCQ reported allergic reactions or rash.

Most of the patients were women. The mean age was 58.

“I always wanted to see a randomized trial of this question,” said Grace Lo MD, a rheumatologist at Baylor College of Medicine, during the discussion period. “I’m a little depressed at the results.”

However, she noted that the researchers did not measure inflammation at baseline, and excluded patients with involvement of both hands or a Kellgren Lawrence Grade of 4. Thus it remains possible that the drug may be effective for patients with severe hand OA.

It would also be interesting to see whether there are differences between effects on the distal and proximal joints of the hand, Lo added.