Background Pharmacological treatment options for hand osteoarthritis (OA) are limited. Hydroxychloroquine (HCQ) has been used successfully in the treatment of mild rheumatoid arthritis for many years and is believed to be beneficial in hand OA also.

Purpose In this trial we studied the symptom modifying effect of HCQ in primary hand OA.

Methods We conducted a randomised, double blind, placebo controlled, multicentre trial in patients with primary hand OA. Patients received either hydroxychloroquine 400 mg once a day or placebo during a treatment period of 24 weeks. The primary outcome was decrease in hand pain in the previous 24 hours on a 100 mm visual analogue scale (VAS). Secondary outcomes included change in total score of the Australian Canadian Hand Osteoarthritis Index (AUSCAN) and the Arthritis Impact Measurement Scale 2 SF (AIMS2-SF).

Results 196 patients were included (placebo n=98, HCQ n=98). Mean (SD) age was 57 (7.4) years; 86% were women. Baseline median (IQR) pain VAS was 50.0 (24.5–62.5) mm in the placebo group and 45.0 (26.0–60.3) mm in the HCQ group. At 24 weeks, change in pain VAS was not significantly different between the two groups. There were also no statistically significant differences in pain VAS at weeks 6 and 12. Changes in AUSCAN total score and AIMS2-SF total score in both groups were similar.

Conclusions This study shows that 24 weeks of treatment with HCQ in symptomatic hand OA did not reduce pain compared with placebo. Also, no difference was observed in the change in AUSCAN or AIMS2-SF scores between the two treatment groups. These results suggest that HCQ should not be prescribed in patients with primary hand OA with mild to moderate pain symptoms.