From the Guidelines
Plaquenil (hydroxychloroquine) is not recommended for the treatment of osteoarthritis. According to the most recent and highest quality study, the 2022 American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline summary for the management of osteoarthritis of the knee, the primary approach to treating osteoarthritis involves non-pharmacological methods such as weight management, physical therapy, and exercise, followed by medications like acetaminophen, NSAIDs, or topical treatments if necessary 1.
The use of Plaquenil, which is primarily indicated for autoimmune conditions like rheumatoid arthritis and lupus, does not address the mechanical wear-and-tear mechanism of osteoarthritis. Furthermore, Plaquenil carries significant risks of serious side effects, including retinal toxicity, cardiac issues, and blood disorders, making its risk-benefit profile unfavorable for osteoarthritis treatment where safer and more effective options are available.
Key considerations in managing osteoarthritis include:
- Non-pharmacological approaches as the first line of treatment
- Use of acetaminophen or NSAIDs for pain management
- Topical treatments for localized pain relief
- Intra-articular corticosteroid injections for acute exacerbations
- Surgical interventions in severe cases
The 2019 American College of Rheumatology (ACR) guideline for the management of osteoarthritis of the hand, hip, and knee also supports the use of non-pharmacological and pharmacological therapies but does not recommend Plaquenil for osteoarthritis treatment 1. Similarly, other studies and guidelines, such as those from 2008 and 2012, emphasize the importance of a stepped approach to osteoarthritis management, starting with the least invasive and safest options, which does not include Plaquenil 1.
Given the potential risks and the availability of more effective and safer alternatives, the use of Plaquenil for osteoarthritis is not supported by current evidence and guidelines.
From the Research
Plaquenil for Osteoarthritis
- There is limited research on the use of Plaquenil (hydroxychloroquine) for osteoarthritis, with some studies suggesting its potential efficacy in treating OA-related pain 2.
- However, the results are contradictory, and a multicenter, randomized, double-blind, placebo-controlled trial (British HERO study) found that hydroxychloroquine was not superior to placebo as an analgesic treatment or for reduction of radiographic progression in hand OA 2.
- Another study is currently underway (OA TREAT study) to evaluate the efficacy of hydroxychloroquine in inflammatory and erosive hand OA, but current evidence does not support its use for OA 2.
Alternative Treatment Options
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are common pharmacologic treatments for OA, with varying levels of efficacy and safety 3, 4.
- Intra-articular NSAIDs may be an alternative therapy, minimizing systemic side effects while maintaining efficacy, and have been shown to be safe and efficacious in animal and human studies 5.
- Other treatment options, such as viscosupplementation injections and intra-articular corticosteroid injections, may provide short-term pain relief for mild to moderate knee osteoarthritis 6.