Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand Osteoarthritis: A Randomized Trial

Sarah R Kingsbury, Puvan Tharmanathan, Ada Keding, Sarah J Ronaldson, Andrew Grainger, Richard J. Wakefield, Catherine Arundel, Fraser Birrell, Michael Doherty, Tonia L Vincent, Fiona E Watt, Krysia S Dziedzic, Terence W O'Neill, Nigel K Arden, David L Scott, John Dickson, Toby Garrood, Michael Green, Ajit Menon, Tom SheeranDavid Torgerson, Philip G. Conaghan

Research output: Contribution to journalArticlepeer-review


Background: Synovitis is believed to play a role in producing symptoms in persons with hand osteoarthritis, but data on slow-acting anti-inflammatory treatments are sparse.

Objective: To determine the effectiveness of hydroxychloroquine versus placebo as an analgesic treatment of hand osteoarthritis.

Design: Randomized, double-blind, placebo-controlled clinical trial with 12-month follow-up. (ISRCTN registry number: ISRCTN91859104).

Setting: 13 primary and secondary care centers in England.

Participants: Of 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.

Intervention: Hydroxychloroquine (200 to 400 mg) or placebo (1:1) for 12 months with ongoing usual care.

Measurements: The 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.

Results: At 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).

Limitation: Hydroxychloroquine dosage restrictions may have reduced efficacy.

Conclusion: Hydroxychloroquine was no more effective than placebo for pain relief in patients with moderate to severe hand pain and radiographic osteoarthritis.

Primary Funding Source: Arthritis Research UK.

Original languageEnglish
Pages (from-to)385-395
Number of pages14
JournalAnnals of Internal Medicine
Issue number6
Early online date20 Feb 2018
Publication statusE-pub ahead of print - 20 Feb 2018

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© 2018, American College of Physicians. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.


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