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Hougum, B. (2015). Hydroxychloroquine in the Treatment of Osteoarthritis.
Background: Osteoarthritis (OA) accounts for one of the most common causes of loss of work and disability in America. Traditional treatments are aimed at symptomatic relief and maintaining functional capacity, but have not been shown to modify disease progression. Evidence for inflammatory and immune components in the development of OA lend support to expanding treatment options to potentially slow the disease and delay the need for invasive surgical intervention. Hydroxychloroquine (HCQ) is known for its use as an antimalarial and as a DMARD for rheumatoid arthritis, but has also been considered an option for treatment resistant OA. Several studies have looked at the medication’s potential for symptomatic relief, and have touched on the possibility of slowing disease progression in OA, but resources cite the drug as “uncertain benefit” in the realm of OA treatment. In patients with osteoarthritis, can hydroxychloroquine provide symptomatic improvement?
Method: An exhaustive search using MEDLINE-Ovid, Web of Science, and CINAHL was performed using keywords: osteoarthritis and hydroxychloroquine. These were screened with eligibility criteria. The resulting studies were then appraised and assessed for quality with GRADE. Current NIH clinical trials were found to include two active studies relating to the use of HCQ in OA, with one for hand OA, and the other combining HCQ and a statin for knee OA.
Results: Three studies were included in this systematic review, meeting the inclusion and exclusion criteria. One RCT looked at 44 patients with knee OA and showed overall improvement in pain, stiffness, and function with the treatment of HCQ. A retrospective observational study demonstrated that 6 of 8 patients with erosive hand OA, on the same dose of HCQ, responded to the treatment with global improvement, decreased synovitis, and decreased stiffness. Another RCT showed that patients with erosive hand OA had improvement in joint tenderness, and also saw decreased physiological markers of inflammation and immune destruction after treatment with HCQ.
Conclusion: Hydroxychloroquine has been shown to provide symptomatic improvement in patients with OA, both in hand and knee OA, and is a reasonable treatment option for patients resistant to traditional first line analgesics. To a smaller extent, the drug effect has been assessed on a physiological basis with laboratory markers, and shown positive results in this respect. Further research into the disease modifying potential and larger clinical trials are needed in order to further validate this treatment and determine the OA subsets and patient populations that it would most benefit.
Kingsbury, S., Tharmanathan, P., Adamson, J., Arden, N., Birrell, F., Cockayne, S., Dickson, J., Doherty, M., Dziedzic, K., Grainger, A., Hewitt, C., O'Neill, T., Scott, D., Vincent, T., Wakefield, R., Watt, F., Torgerson, D., & Conaghan, P. (2013). Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis (HERO): study protocol for a randomized controlled trial. Trials, 14, 64 - 64.
Detert, J., Klaus, P., Listing, J., Höhne-Zimmer, V., Braun, T., Wassenberg, S., Rau, R., Buttgereit, F., & Burmester, G. (2014). Hydroxychloroquine in patients with inflammatory and erosive osteoarthritis of the hands (OA TREAT): study protocol for a randomized controlled trial. Trials, 15.
Jokar, M., Mirfeizi, Z., & Keyvanpajouh, K. (2013). The Effect of Hydroxychloroquine on Symptoms of Knee Osteoarthritis: A Double-Blind Randomized Controlled Clinical Trial. Iranian Journal of Medical Sciences, 38, 221 - 226.
Background: Osteoarthritis is a degenerative joint disorder of articular cartilage and is the most common type of arthritis in the elderly. There are only a few reports regarding the use of Hydroxychloroquine in the treatment of osteoarthritis. Methods: To investigate the effects of Hydroxychloroquine on the symptoms of mild to moderate knee osteoarthritis (Kellgren and Lawrence grade II and III),we performed a double-blind, placebo-controlled study in 44 patients. The patients were randomly assigned to two groups: one group received Hydroxychloroquine pills (200 mg twice daily) and the other group received placebo pills. Symptoms were assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at the end of weeks 4, 8, 12, 16, 20, and 24. Results: Approximately, 98% of the patients were women at an average age of 47 years. There was no significant difference in the baseline characteristics between the two groups. In the placebo group, maximum improvement occurred at the 4th week; and during the remaining time, there was no significant improvement. In the Hydroxychloroquine group, maximum improvement occurred at the 8th week and persisted over the entire remaining follow-up period. There were significant differences between the two groups regarding the degree of reduction in the WOMAC total score and the WOMAC subscales scores of pain, stiffness, and function at the end of weeks 4, 8, 12, 16, 20, and 24.
Conclusion: Hydroxychloroquine conferred significant improvement in the symptoms of mild to moderate knee osteoarthritis in our patients and may, accordingly, be recommended for knee osteoarthritis treatment.
Bryant, L., Rosier, K.F., & Carpenter, M. (1995). Hydroxychloroquine in the treatment of erosive osteoarthritis. The Journal of rheumatology, 22 8, 1527-31 .
Hougum, B. (2015). Hydroxychloroquine in the Treatment of Osteoarthritis.
Background: Osteoarthritis (OA) accounts for one of the most common causes of loss of work and disability in America. Traditional treatments are aimed at symptomatic relief and maintaining functional capacity, but have not been shown to modify disease progression. Evidence for inflammatory and immune components in the development of OA lend support to expanding treatment options to potentially slow the disease and delay the need for invasive surgical intervention. Hydroxychloroquine (HCQ) is known for its use as an antimalarial and as a DMARD for rheumatoid arthritis, but has also been considered an option for treatment resistant OA. Several studies have looked at the medication’s potential for symptomatic relief, and have touched on the possibility of slowing disease progression in OA, but resources cite the drug as “uncertain benefit” in the realm of OA treatment. In patients with osteoarthritis, can hydroxychloroquine provide symptomatic improvement?
Method: An exhaustive search using MEDLINE-Ovid, Web of Science, and CINAHL was performed using keywords: osteoarthritis and hydroxychloroquine. These were screened with eligibility criteria. The resulting studies were then appraised and assessed for quality with GRADE. Current NIH clinical trials were found to include two active studies relating to the use of HCQ in OA, with one for hand OA, and the other combining HCQ and a statin for knee OA.
Results: Three studies were included in this systematic review, meeting the inclusion and exclusion criteria. One RCT looked at 44 patients with knee OA and showed overall improvement in pain, stiffness, and function with the treatment of HCQ. A retrospective observational study demonstrated that 6 of 8 patients with erosive hand OA, on the same dose of HCQ, responded to the treatment with global improvement, decreased synovitis, and decreased stiffness. Another RCT showed that patients with erosive hand OA had improvement in joint tenderness, and also saw decreased physiological markers of inflammation and immune destruction after treatment with HCQ.
Conclusion: Hydroxychloroquine has been shown to provide symptomatic improvement in patients with OA, both in hand and knee OA, and is a reasonable treatment option for patients resistant to traditional first line analgesics. To a smaller extent, the drug effect has been assessed on a physiological basis with laboratory markers, and shown positive results in this respect. Further research into the disease modifying potential and larger clinical trials are needed in order to further validate this treatment and determine the OA subsets and patient populations that it would most benefit.
Kingsbury, S., Tharmanathan, P., Adamson, J., Arden, N., Birrell, F., Cockayne, S., Dickson, J., Doherty, M., Dziedzic, K., Grainger, A., Hewitt, C., O'Neill, T., Scott, D., Vincent, T., Wakefield, R., Watt, F., Torgerson, D., & Conaghan, P. (2013). Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis (HERO): study protocol for a randomized controlled trial. Trials, 14, 64 - 64.
Detert, J., Klaus, P., Listing, J., Höhne-Zimmer, V., Braun, T., Wassenberg, S., Rau, R., Buttgereit, F., & Burmester, G. (2014). Hydroxychloroquine in patients with inflammatory and erosive osteoarthritis of the hands (OA TREAT): study protocol for a randomized controlled trial. Trials, 15.
Jokar, M., Mirfeizi, Z., & Keyvanpajouh, K. (2013). The Effect of Hydroxychloroquine on Symptoms of Knee Osteoarthritis: A Double-Blind Randomized Controlled Clinical Trial. Iranian Journal of Medical Sciences, 38, 221 - 226.
Background: Osteoarthritis is a degenerative joint disorder of articular cartilage and is the most common type of arthritis in the elderly. There are only a few reports regarding the use of Hydroxychloroquine in the treatment of osteoarthritis. Methods: To investigate the effects of Hydroxychloroquine on the symptoms of mild to moderate knee osteoarthritis (Kellgren and Lawrence grade II and III),we performed a double-blind, placebo-controlled study in 44 patients. The patients were randomly assigned to two groups: one group received Hydroxychloroquine pills (200 mg twice daily) and the other group received placebo pills. Symptoms were assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at the end of weeks 4, 8, 12, 16, 20, and 24. Results: Approximately, 98% of the patients were women at an average age of 47 years. There was no significant difference in the baseline characteristics between the two groups. In the placebo group, maximum improvement occurred at the 4th week; and during the remaining time, there was no significant improvement. In the Hydroxychloroquine group, maximum improvement occurred at the 8th week and persisted over the entire remaining follow-up period. There were significant differences between the two groups regarding the degree of reduction in the WOMAC total score and the WOMAC subscales scores of pain, stiffness, and function at the end of weeks 4, 8, 12, 16, 20, and 24.
Conclusion: Hydroxychloroquine conferred significant improvement in the symptoms of mild to moderate knee osteoarthritis in our patients and may, accordingly, be recommended for knee osteoarthritis treatment.
Bryant, L., Rosier, K.F., & Carpenter, M. (1995). Hydroxychloroquine in the treatment of erosive osteoarthritis. The Journal of rheumatology, 22 8, 1527-31 .
