Hydroxychloroquine and Colchicine in Hand Osteoarthritis at the 2020 EULAR Online Meeting

Hydroxychloroquine and colchicine in hand osteoarthritis isn't so far from the main stream of medicine. Hydroxychloroquine is important in the treatment of systemic lupus erythematodes. The current president of the U.S.A. has been advocating hydroxchloquine to fight covid-19 disease, though lacking scientific support. For colchicine there have been studies concerning osteoarthritis of weight bearing joints, mostly knee osteoarthritis.

For hydroxychloroquine and colchicine in hand osteoarthritis there have been two studies at the 2020 EULAR Online Meeting.

But let me start with a study by L.R Bryant and colleagues in 1995 [1]: „Hydroxychloroquine in the Treatment of Erosive Osteoarthritis“. The study had been underpowered (N=8). The authors concluded: „The use of hydroxychloroquine in patients with erosive OA unresponsive to NSAID appears promising. Prospective studies are needed to confirm our observations.“

C. Kedor and colleagues presented [2] at the 2020 EULAR Online Meeting: „OP0186 HYDROXYCHLOROQUINE IN PATIENTS WITH INFLAMMATORY AND EROSIVE OSTEOARTHRITIS OF THE HANDS: RESULTS OF A RANDOMIZED, DOUBLEBLIND, PLACEBO CONTROLLED, MULTI-CENTRE, INVESTIGATOR-INITIATED TRIAL (OA TREAT)“. The study originated in 2014. „The primary endpoint was AUSCAN for pain and hand disability at week 52 (W52). A secondary endpoint was radiographic progression from baseline (BL) to W52.“ „Of 156 patients 3 were excluded and 75 were randomized to HCQ and 78 to PBO.“ With only morning stiffness having been significantly reduced in the HCQ group, the authors had to conclude: „HCQ was no more effective than PBO for changes in pain, function and radiographic scores in the 52-week period.“

The study is congruent with a study that originated in 2013 and had been published earlier [3]: „Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand Osteoarthritis: A Randomized Trial“. „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.“ The authors concluded: „Hydroxychloroquine was no more effective than placebo for pain relief in patients with moderate to severe hand pain and radiographic osteoarthritis.“

So we now have two large randomized studies showing that hydroxychloroquine is ineffective in hand osteoarthritis.

C. Davis and colleagues presented [4]: „FRI0399 COLCHICINE IS NOT EFFECTIVE FOR REDUCING OSTEOARTHRITIC HAND PAIN COMPARED TO PLACEBO: A RANDOMISED, PLACEBO-CONTROLLED TRIAL (COLAH)“. Colchicine is effective as an anti-inflammatory agent in gouty arthritis, but has not been investigated before in hand osteoarthritis. The authors could evaluate 58 participants, who completed the study (N=27 colchicine, N=31 placebo). The authors concluded: „Colchicine 1mg daily for 12 weeks was not effective in improving pain, tender and swollen joint count or grip strength in symptomatic hand osteoarthritis patients. This study does not support colchicine for treatment of symptoms of hand osteoarthritis.“

It would have been nice to have drugs to prevent progression and treat symptoms of hand osteoarhritis, but hydroxychloroquine and colchicine are ineffective and should not be prescribed in patients with (erosive) hand osteoarthritis.

Links and References:

[1] Bryant LR, des Rosier KF, Carpenter MT. Hydroxychloroquine in the treatment of erosive osteoarthritis. J Rheumatol. 1995;22(8):1527-1531.

[2] C. Kedor1, J. Detert2, R. Rau3, S. Wassenberg3, J. Listing4, P. Klaus5, T. Braun1, W. Hermann6, S. Weiner7, M. Bohl-Buhler8, F. Buttgereit1, G. R. Burmester1. OP0186 HYDROXYCHLOROQUINE IN PATIENTS WITH INFLAMMATORY AND EROSIVE OSTEOARTHRITIS OF THE HANDS: RESULTS OF A RANDOMIZED, DOUBLEBLIND,

PLACEBO CONTROLLED, MULTI-CENTRE, INVESTIGATOR-INITIATED TRIAL (OA TREAT). DOI: 10.1136/annrheumdis-2020-eular.819

[3] Kingsbury SR, Tharmanathan P, Keding A, et al. Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand Osteoarthritis: A Randomized Trial. Ann Intern Med. 2018;168(6):385-395. doi:10.7326/M17-1430

[4] C. Davis1,2, C. Ruediger1,2, K. Dyer2, S. Lester1,2, S. Graf3, F. P. B. Kroon4, S. Whittle2, C. Hill1,2. FRI0399 COLCHICINE IS NOT EFFECTIVE FOR REDUCING OSTEOARTHRITIC HAND PAIN COMPARED TO PLACEBO: A RANDOMISED, PLACEBO-CONTROLLED TRIAL (COLAH). DOI: 10.1136/annrheumdis-2020-eular.4040

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