From the Guidelines
Hydroxychloroquine (Plaquenil) is not recommended as a monotherapy for treating Rheumatoid Arthritis (RA) due to its limited efficacy in controlling disease activity and preventing structural damage, especially when compared to other disease-modifying antirheumatic drugs (DMARDs) like methotrexate 1.
Key Points to Consider
- The 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis strongly recommends methotrexate over hydroxychloroquine for DMARD-naive patients with moderate-to-high disease activity 1.
- Hydroxychloroquine may be considered as monotherapy only in patients with very mild RA who have contraindications to other compounds, but its use is limited by its inability to inhibit structural damage sufficiently 1.
- The typical hydroxychloroquine dosage is 200-400 mg daily, but it works slowly, taking 2-6 months to reach full effectiveness.
- Patients using hydroxychloroquine should have baseline and periodic eye exams to monitor for rare retinal toxicity.
Treatment Recommendations
- For most RA patients, methotrexate is the preferred first-line DMARD, often started at 7.5-15 mg weekly and titrated up as needed.
- Combination conventional DMARDs or the addition of biologics or JAK inhibitors may be necessary to achieve remission or low disease activity in most patients.
- The choice of treatment should be individualized based on disease severity, patient preferences, and potential side effects.
From the Research
Efficacy of Hydroxychloroquine as Monotherapy for Rheumatoid Arthritis
- Hydroxychloroquine has been shown to be effective in the treatment of rheumatoid arthritis, with studies demonstrating its efficacy in reducing symptoms and improving patient outcomes 2.
- However, the efficacy of hydroxychloroquine as a monotherapy is considered moderate compared to other treatments, such as methotrexate or sulfasalazine 3.
- One study found that hydroxychloroquine alone significantly influenced only three clinical variables and none of the laboratory parameters in patients with rheumatoid arthritis 4.
Comparison with Combination Therapy
- Combination therapy with hydroxychloroquine and other disease-modifying antirheumatic drugs (DMARDs) has been shown to be more effective than hydroxychloroquine monotherapy in treating rheumatoid arthritis 5, 4.
- The addition of hydroxychloroquine to other DMARDs, such as methotrexate and sulfasalazine, can increase clinical efficacy and provide some clinical improvement in patients with inadequate response to previous treatments 5, 3.