Hydroxychloroquine Shows No Significant Benefit for Hand Function in Systemic Sclerosis: Study

The study, based on data from the European Scleroderma Trials and Research (EUSTAR) database, aimed to assess the clinical utility of HCQ in a large cohort of systemic sclerosis patients. S. Bellando-Randone, Department of Experimental and Clinical Medicine, University of Florence, Division of Rheumatology Scleroderma Unit, AOU Careggi Hospital, Florence, Italy, and colleagues evaluated the medication's impact on physical function and hand mobility over time. Patients treated with HCQ for at least six months were identified and compared with a matched group of non-HCQ users, with matching conducted based on variables such as age, gender, disease duration, and concomitant medication use.

The study led to the following findings:

• Of 17,805 systemic sclerosis patients in the EUSTAR registry, only 468 (2.6%) received hydroxychloroquine treatment.
• Among those treated with HCQ, 50 patients had at least two assessments of the Health Assessment Questionnaire Disability Index (HAQ-DI), and 44 had comparable evaluations for the Cochin Hand Function Scale (CHFS).
• HAQ-DI and CHFS were the primary tools to assess changes in daily activity performance and hand function.
• A 3:1 propensity score matching was applied to compare HCQ users with a control group, ensuring balanced baseline characteristics such as age, gender, disease type, and concurrent medications.
• No statistically significant differences were observed between HCQ users and controls in HAQ-DI or CHFS scores over a follow-up period of up to one year.
• The results indicate that HCQ did not lead to meaningful improvement in functional ability or hand function in patients with systemic sclerosis.

The researchers acknowledged several limitations. Notably, this was a retrospective observational analysis rather than a randomized controlled trial, which inherently introduces the possibility of selection bias. For instance, HCQ may have been preferentially prescribed to patients with milder disease. Additionally, data availability was limited, and joint-related metrics such as swollen or tender joint counts were not included in the registry. The study also lacked data on treatment adherence, which may have influenced the outcomes.

"Despite these constraints, the study represents the largest cohort analysis to date examining HCQ’s role in systemic sclerosis. The findings underscore the need for well-designed prospective trials to determine whether HCQ has any meaningful therapeutic benefit in SSc," the researchers wrote.

"While HCQ is occasionally used in the treatment of systemic sclerosis, this study found no clear evidence supporting its effectiveness in improving hand function or activities of daily living in affected patients over one year," they concluded.

Reference:

Bellando-Randone, S., Wilhalme, H., Bruni, C. et al. The effect of hydroxychloroquine on activities of daily living and hand function in systemic sclerosis: results from an analysis of the EUSTAR cohort. Arthritis Res Ther 27, 66 (2025). https://doi.org/10.1186/s13075-025-03476-0