Is there a role for hydroxychloroquine in managing joint pain from long Covid?

Hydroxychloroquine is Not Recommended for Joint Pain from Long COVID

Hydroxychloroquine should not be used for managing joint pain associated with long COVID due to lack of clinical benefit and potential for significant adverse effects. 1

Evidence Against Hydroxychloroquine in COVID-19

The European Respiratory Society (ERS) has issued a strong recommendation against using hydroxychloroquine in patients with COVID-19, including both hospitalized patients and outpatients 1. This recommendation is based on:

• Large randomized controlled trials (including the UK RECOVERY and WHO SOLIDARITY trials) showing no survival benefit
• No significant positive trends in clinical outcomes
• Increased risk of adverse events (OR 4.23,95% CI 3.30-5.42)

The American College of Physicians similarly concluded that there is very uncertain evidence about the effect of hydroxychloroquine compared to standard treatment for COVID-19 1. Multiple studies have consistently failed to demonstrate meaningful clinical benefits.

Safety Concerns

Hydroxychloroquine carries significant risks that outweigh any theoretical benefit for long COVID joint pain:

• Cardiovascular effects: QT interval prolongation and conduction abnormalities 2
• Gastrointestinal symptoms: Nausea, vomiting, diarrhea, and abdominal discomfort 2
• Ophthalmologic toxicity: Retinopathy with long-term use 2
• Other adverse effects: Headache, dizziness, skin rashes, and elevated liver enzymes 2

A meta-analysis of randomized trials showed hydroxychloroquine use was associated with an 11% increase in mortality rate during the first COVID-19 wave 3. One study estimated nearly 17,000 hydroxychloroquine-related in-hospital deaths occurred in countries with available data 3.

Evidence from Clinical Trials

A systematic review and meta-analysis of blinded, placebo-controlled randomized clinical trials found:

• No clinical benefits of hydroxychloroquine as treatment for COVID-19 4
• Increased risk for adverse events among those using hydroxychloroquine 4

Another study examining hospitalized COVID-19 patients found hydroxychloroquine may have resulted in harmful effects, with multivariate analysis showing hydroxychloroquine remained significantly associated with death (OR 3.3,95% CI 1.1-9.6) 5.

Alternative Approaches for Long COVID Joint Pain

Since hydroxychloroquine is not recommended, consider these evidence-based approaches for managing joint pain in long COVID:

1. Non-pharmacological interventions:

   • Physical therapy
   • Graded exercise therapy
   • Heat/cold therapy

2. Pharmacological options:

   • Acetaminophen
   • NSAIDs (if not contraindicated)
   • Topical analgesics

3. Referral considerations:

   • Rheumatology consultation for persistent symptoms
   • Pain management specialist for refractory pain

Conclusion

Despite hydroxychloroquine's established role in treating autoimmune inflammatory conditions like lupus and rheumatoid arthritis, there is no evidence supporting its use for joint pain associated with long COVID. Multiple high-quality guidelines and studies demonstrate lack of efficacy and potential harm when used for COVID-19 related conditions. The risk-benefit analysis clearly favors avoiding hydroxychloroquine in this context.