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.
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