Background: Osteoarthritis (OA) accounts for one of the most common causes of loss of work and disability in America. Traditional treatments are aimed at symptomatic relief and maintaining functional capacity, but have not been shown to modify disease progression. Evidence for inflammatory and immune components in the development of OA lend support to expanding treatment options to potentially slow the disease and delay the need for invasive surgical intervention. Hydroxychloroquine (HCQ) is known for its use as an antimalarial and as a DMARD for rheumatoid arthritis, but has also been considered an option for treatment resistant OA. Several studies have looked at the medication’s potential for symptomatic relief, and have touched on the possibility of slowing disease progression in OA, but resources cite the drug as “uncertain benefit” in the realm of OA treatment. In patients with osteoarthritis, can hydroxychloroquine provide symptomatic improvement?
Method: An exhaustive search using MEDLINE-Ovid, Web of Science, and CINAHL was performed using keywords: osteoarthritis and hydroxychloroquine. These were screened with eligibility criteria. The resulting studies were then appraised and assessed for quality with GRADE. Current NIH clinical trials were found to include two active studies relating to the use of HCQ in OA, with one for hand OA, and the other combining HCQ and a statin for knee OA.
Results: Three studies were included in this systematic review, meeting the inclusion and exclusion criteria. One RCT looked at 44 patients with knee OA and showed overall improvement in pain, stiffness, and function with the treatment of HCQ. A retrospective observational study demonstrated that 6 of 8 patients with erosive hand OA, on the same dose of HCQ, responded to the treatment with global improvement, decreased synovitis, and decreased stiffness. Another RCT showed that patients with erosive hand OA had improvement in joint tenderness, and also saw decreased physiological markers of inflammation and immune destruction after treatment with HCQ.
Conclusion: Hydroxychloroquine has been shown to provide symptomatic improvement in patients with OA, both in hand and knee OA, and is a reasonable treatment option for patients resistant to traditional first line analgesics. To a smaller extent, the drug effect has been assessed on a physiological basis with laboratory markers, and shown positive results in this respect. Further research into the disease modifying potential and larger clinical trials are needed in order to further validate this treatment and determine the OA subsets and patient populations that it would most benefit.
Keywords: Hydroxychloroquine, osteoarthritis
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