Leeds, UK—Symptomatic hand osteoarthritis affects up to a third of adults older than 70 years and 15% of those over age 60 years, causing debilitating pain. With few therapies proven effective, physicians sometimes turn to off-label use of hydroxychloroquine to treat it.

A study in Annals of Internal Medicine finds, however, that hydroxychloroquine is no more effective than placebo for relieving moderate-to-severe hand pain and radiographic osteoarthritis. The drug is typically used when acetaminophen and nonsteroidal anti-inflammatory drugs do not have the desired affect and when the prescriber is seeking to avoid initiating opioids, the article notes.

For the trial, researchers from the Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Leeds Biomedical Research Centre randomly assigned 248 participants with symptomatic and radiographic hand osteoarthritis to either hydroxychloroquine (200 mg-400 mg) or placebo for 12 months with ongoing usual care.

Conducted at 13 primary and secondary care centers in England, the study included mostly female participants (82%) with a mean age of 62 years, 7% with symptomatic pain of 4 or more on a 10-point visual analog scale. All had baseline ultrasonography.

The primary end point was defined as change in average hand pain, while secondary end points included self-reported pain and function, grip strength, quality of life, radiographic structural change, and adverse events.

Results after 6 months indicated that 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. Furthermore, researchers identified no significant treatment differences at 3, 6, or 12 months for any secondary outcomes.

“Hydroxychloroquine was no more effective than placebo for pain relief in patients with moderate to severe hand pain and radiographic osteoarthritis,” study authors conclude, adding that some of the hand pain might have been caused by tendon issues, not arthritis, which would have been unaffected by hydroxychloroquine.

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