How do you decide when to try stopping hydroxychloroquine in patients with erosive osteoarthritis?
Do you typically offer a trial of hydroxychloroquine in erosive OA patients?
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As we lack any peer-reviewed evidence that hydroxychloroquine (HCQ) effectively and significantly helps with erosive osteoarthritis, I would stop the drug if there was no relief within 2 months (if I had started it for a patient). While HCQ (and other DMARDs) are often used empirically with these erosive OA patients, expectations remain low.
Kedor et al., PMID 34215704 ran the multicenter double-blind placebo-controlled OA-TREAT study to investigate the efficacy and safety of HCQ in patients with inflammatory/erosive hand OA. 150 patients were randomized for the 52-week study, but there weren't any differences in hand pain, disability or radiographic scores between the two groups.
The search for the first true DMOAD continues, for hand OA (and erosive hand OA) as with other subsets of OA!