From the Guidelines
Plaquenil (hydroxychloroquine) is a recommended treatment for rheumatoid arthritis (RA) as it helps reduce inflammation, pain, and joint damage, and is considered a safer disease-modifying antirheumatic drug (DMARD) for long-term management. According to the 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis 1, hydroxychloroquine is listed as a conventional DMARD (csDMARD) approved by the US FDA for the treatment of RA. The guideline emphasizes the importance of early evaluation, diagnosis, and management of RA, and recommends treatment decisions to be made through a shared decision-making process.
Key Points
- Plaquenil is often prescribed as part of a comprehensive RA treatment plan, sometimes in combination with other medications like methotrexate for enhanced effectiveness 1.
- The typical dosage for adults with RA is 200-400 mg daily, often taken as a single daily dose or divided into two doses.
- Most patients begin to notice improvement after 4-12 weeks of consistent use.
- Regular eye exams are necessary while taking Plaquenil due to the rare risk of retinal damage with long-term use.
- Common side effects may include nausea, headache, and skin rashes, but serious side effects are relatively uncommon.
Treatment Approach
The 2020 EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs also support the use of hydroxychloroquine as a first-line treatment for RA 1. The recommendations emphasize the importance of starting therapy with DMARDs as soon as the diagnosis of RA is made, and adjusting treatment if there is no improvement by at most 3 months after the start of treatment or the target has not been reached by 6 months. The goal of treatment is to reach a target of sustained remission or low disease activity (LDA) in every patient, and hydroxychloroquine is considered a valuable option in achieving this goal.
From the Research
Efficacy of Plaquenil in Rheumatoid Arthritis
- The study 2 compared the efficacy of basic RA treatment with methotrexate and plaquenil to basic monotherapy with methotrexate, and found that combined basic therapy was more effective, producing good effects more frequently and earlier.
- Another study 3 found that combination therapy with sulphasalazine, methotrexate, hydroxychloroquine, and prednisolone was better than single-drug therapy in inducing remission in early rheumatoid arthritis.
- A study 4 compared the efficacy and tolerability of triple combination therapy with methotrexate, sulfasalazine, and hydroxychloroquine to methotrexate monotherapy, and found that the triple combination was more effective and well-tolerated.
- The study 5 compared the efficacy of combination therapy with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, and a combination of the three medications, and found that the triple combination was the most effective.
Combination Therapy with Plaquenil
- The studies 2, 3, 4, 5 suggest that combination therapy with plaquenil and other disease-modifying antirheumatic drugs (DMARDs) is more effective than monotherapy in treating rheumatoid arthritis.
- The study 5 found that the triple combination of methotrexate, sulfasalazine, and hydroxychloroquine was well-tolerated and had superior efficacy to the double combinations of methotrexate and hydroxychloroquine or methotrexate and sulfasalazine.
Safety and Tolerability
- The study 6 found no statistically significant association between the use of methotrexate, sulfasalazine, or hydroxychloroquine and incident fractures in postmenopausal women with rheumatoid arthritis.
- The studies 2, 3, 4, 5 suggest that combination therapy with plaquenil is generally well-tolerated, with similar frequencies of adverse events to monotherapy.