What can be taken with hydroxychloroquine for pain control or anti-inflammation?

Medications for Pain Control and Anti-Inflammation with Hydroxychloroquine

For inflammatory rheumatic conditions, NSAIDs with gastroprotection (such as proton pump inhibitors) can be used alongside hydroxychloroquine for pain control, while low-dose colchicine (0.5 mg twice daily) serves as an effective anti-inflammatory option for crystal arthropathies. 1

NSAIDs with Gastroprotection

• NSAIDs are recommended in combination with gastro-protective agents such as proton pump inhibitors, particularly in older patients or those requiring long-term use, to prevent gastrointestinal bleeding 1
• This combination is appropriate for both acute inflammatory episodes and chronic inflammatory arthritis when used with hydroxychloroquine 1
• The evidence base for NSAIDs comes from research in gout and osteoarthritis, which supports their use in inflammatory conditions 1

Low-Dose Colchicine

• Colchicine 0.5 mg twice daily demonstrated significant anti-inflammatory efficacy in a placebo-controlled trial for inflammatory arthritis with CPPD 1
• The number needed to treat (NNT) for >30% pain reduction was 2 (95% CI 1 to 4) at 4 months 1
• Side effects were minor (primarily dyspepsia) with no marked diarrhea documented at this low dose 1
• This represents an effective option for crystal-associated inflammatory conditions when combined with hydroxychloroquine 1

Low-Dose Glucocorticoids

• Short courses of low-dose oral glucocorticoids can be used for acute inflammatory flares in patients already taking hydroxychloroquine 1
• For chronic inflammatory pain, avoid repeated use of glucocorticoids; instead prioritize non-pharmacological management and the medications listed above 1

What NOT to Use

• Avoid repeated or chronic NSAID use without gastroprotection due to bleeding risk, especially in older patients 1
• Do not use hydroxychloroquine itself as primary pain control—it functions as a disease-modifying agent with immunomodulatory effects rather than direct analgesic properties 1
• Methotrexate is not recommended for pain control in osteoarthritis and should not be added solely for analgesia 1

Important Monitoring Considerations

• Patients already on chronic hydroxychloroquine therapy should continue it during acute infections (including COVID-19) due to immunomodulatory benefits and risk of disease flares 2
• Baseline ophthalmologic examination is required before starting hydroxychloroquine, with annual screening after 5 years for low-risk patients 2
• Check G6PD levels in men of African, Asian, or Middle Eastern origin before starting hydroxychloroquine to avoid hemolysis 2
• Monitor for photosensitivity when combining hydroxychloroquine with doxycycline (if treating concurrent infections) 2

Clinical Context

The key principle is that hydroxychloroquine provides disease modification and immunomodulation, not direct analgesia 1. Therefore, symptomatic pain control requires additional agents. For inflammatory conditions like Sjögren's syndrome or chronic inflammatory arthritis, hydroxychloroquine may reduce inflammatory pain over weeks to months, but acute pain requires NSAIDs or colchicine 1. For non-inflammatory chronic pain, physical activity and aerobic exercise should be emphasized over medications, with consideration of antidepressants or anticonvulsants (gabapentin, pregabalin, amitriptyline) for neuropathic components 1.