Pinky Finger Arthritis, Rheumatoid Arthritis, Psoriatic Arthritis & Plaquenil ( Hydroxychloroquine )
Painful Hand OA Not Relieved by Hydroxychloroquine
Exercise, not an immunosuppressant drug, may be most effective for hand OA pain.
By Brian P. Dunleavy
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February 20, 2019
If you’re taking hydroxychloroquine for your hand osteoarthritis (OA) and expecting relief from the painful symptoms of the disease, you may want to hold it — figuratively speaking.
Although the quinoline, which was originally approved as a treatment for malaria, has been used “off-label” for decades in the management of various forms of rheumatoid arthritis, as well as for hand OA, because of its ability to reduce inflammation and improve joint function (as demonstrated in clinical trials), recent research published in November 2019 in the journalArthritis Care & Researchsuggests it may not be effective at addressing the pain associated with the condition.
In fact, a recent study published February 19, 2019, in the journalAnnals of Internal Medicine, which was performed at the Leeds Institute of Rheumatic and Musculoskeletal Medicine in the United Kingdom, found that the drug performed only moderately better than placebo in reducing the pain associated with hand OA.
“Further work is still needed to unravel the molecular mechanisms of inflammation in OA and its role in symptoms and disease progression, and [results of such work] may provide alternative therapeutic targets for the focus of future research,” says study lead author Sarah Kingsbury, PhD, osteoarthritis strategic lead and deputy section head of musculoskeletal medicine and imaging at the Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds.
“In addition, better patient phenotyping will improve our understanding of the drivers of hand pain and enable exclusion of other causes of hand pain, such as tenosynovitis. We increasingly believe that a lot of hand pain is due to tendon problems that result in pain, up to 30 minutes of finger stiffness in the mornings, and swelling of fingers. If you can’t undo a jar, you will have muscle weakness, which causes these tendon problems. We need to address this common cause of pain by having patients and doctors focus on appropriate forearm strengthening exercises.”
For their recent study, Dr. Kingsbury and her colleagues randomly assigned 248 participants with symptomatic and radiographic hand OA to receive treatment with either hydroxychloroquine (at doses of 200 to 400 milligrams per day) or placebo, along with their regular care, for a period of 12 months. Notably, at six months, mean hand pain (on a scale of 1 to 10) was 5.49 points in the placebo group and 5.66 points in the hydroxychloroquine group, meaning that the drug was no more effective than placebo for pain relief.
But the news on hydroxychloroquine wasn’t all bad. According to Kingsbury, an exploratory analysis performed by the team identified “a statistical association between patients who had a stronger grip strength and pain relief from hydroxychloroquine.” The team believes that this may be an additional indication that the hand pain among those with OA may be the result of tendon issues — namely, tenosynovitis or enthesitis, two common forms of tendinitis — as opposed to arthritis pain.
“Hydroxychloroquine would not be expected to have an effect on such pain,” Kingsbury explains. “These findings emphasize the importance of including strengthening exercises in the management of osteoarthritis, a core treatment recommended by the National Institute for Health and Care Excellence (NICE) and the American College of Rheumatology.”
Previous research has estimated that 1 in 12 adults over age 60 in the United States have hand OA. Although there is no exact data on the number of them who have been using hydroxychloroquine, Angie Dickerson-Schnatz, a specialist in hand physical therapy at Premier Orthopaedics in Newtown Square, Pennsylvania, suggests its role as the therapy of choice for hand OA has been on the decline as research highlights its limited efficacy and expands clinicians’ understanding of the condition and the root causes of its symptoms.
“[Hydroxychloroquine] is used for treatment of rheumatoid or autoimmune conditions, and osteoarthritis is more of a degenerative condition, so I can see how [it may not be as effective],” she says. Dickerson-Schnatz wasn’t part of the Leeds study team.
“As therapists treating hands, we deal with the physical ways that patients can protect their joints to avoid stress and pain, while the physicians address the medication,” she says. “We will monitor a patient’s pain complaints as they are taking a medication, but we are teaching them [how] to avoid the joint stress and loading that leads to pain.
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