At the EULAR Annual Meeting 2015 in Rome I’ve seen two abstracts / posters on osteoarthritis and DMARDs, actually both abstracts looked at hydroxychloroquine (HCQ)
N. Cid Boza and colleagues published [AB0865]: “Hydroxychloroquine in the symptomatic control of erosive hand osteoarthritis”. “A total of 10 patients were included between July 2012 and July 2013 and all completed a 24 weeks follow up.” “A 50% of patients reached a reduction of at least 20% of pain assessment by AUSCAN pain domain …”. They concluded: “Our results suggest that hydroxychloroquine may decrease inflammatory activity in erosive hands OA and thus functional impairment after 24 weeks … Hydroxychloroquine was well tolerated and no major side effects were observed.”
N=10 isn’t much to draw conclusions upon! It is unclear, how “inflammatory activity” has been measured. All in all, I cannot see any advantage of hydroxychloroquine over non-treatment. No major side effects in 10 patients is underrating the known risks of the drug.
N. Basoski and colleagues looked at [OP0304]: “Efficacy of hydroxychloroquine in primary hand osteoarthritis: a randomized, double-blind, placebo controlled trial.” They concluded: “This study shows that 24 weeks of treatment with HCQ in symptomatic hand OA did not reduce pain when compared to placebo. Also, no effect was observed in change of AUSCAN total and subscales scores or AIMS2-SF scores between both treatment groups. These results suggest that HCQ should not be prescribed in patients with primary hand OA with mild to moderate pain symptoms.”
Well, this study had been designed double-blind, placebo controlled, and was with N=98 in both groups well powered. The authors didn’t want to rule out that HCQ could be useful in other phenotypes of hand OA.
Not let’s come to the PLUS …
Today I’ve received the September issue of Annals of rheumatic diseases. X. Chevalier and colleagues published: Adalimumab in patients with hand osteoarthritis refractory to analgesics and NSAIDs: a randomised, multicenter, double-blind, placebo-controlled trial.” [Chevalier, X, et al. Ann Rheum Dis 2015;74: 1697-1705. doi:10.1136/annrheumdis-2014-205348] The authors concluded that “Adalimumab was not superior to placebo to alleviate pain in patients with hand OA not responding to analgesics and NSAIDs.”
We might conclude that DMARDs that are effective in rheumatoid arthritis and/or psoriatic arthritis might not work in osteoarthritis, even if joint destruction in the end might look similar. We might go on testing other traditional or biological DMARDs, but my guess is that it’s a dead end.
We should put the focus on studying how the process of joint degradation is started, maintained, and timed in osteoarthritis, before we look, which drug may have a chance to counteract this process.