Methotrexate and Hydroxychloroquine Combo may significantly Improve Outcomes in Rheumatoid Arthritis: Study

A recent study published in the International Journal of Rheumatic Diseases compared the efficacy and safety of combination therapy with methotrexate (MTX) plus hydroxychloroquine (HCQ) versus MTX monotherapy in patients with rheumatoid arthritis (RA) and found promising results. The study included a total of 60 patients and were randomly divided into 2 groups. One group received a combination of MTX and HCQ, while the other received only MTX.

Both groups were monitored for 12 weeks, with data collected on several key measures like pain intensity using the visual analogue scale (VAS), disease activity score (DAS) in 28 joints, serum inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). The World Health Organization Quality of Life Brief Version questionnaire (WHOQOL-BREF) was also used to assess quality of life. Adverse reactions were recorded throughout the trial to gauge safety.

At the end of the 12-week trial, the group treated with the combination of MTX and HCQ demonstrated significantly greater improvements across all evaluated parameters when compared to the group receiving MTX monotherapy. The patients on combination therapy experienced a more notable decrease in pain scores than the patients on MTX alone. This suggests that the addition of HCQ may provide improved relief from the chronic discomfort associated with RA.

The combination therapy group showed a more substantial reduction in disease activity which indicated a better control of joint inflammation and swelling. Serum levels of CRP, ESR, IL-6, and TNF-α were significantly reduced in patients who were receiving the combination treatment that reflected lower systemic inflammation. These results suggest that HCQ, in combination with MTX, has a synergistic anti-inflammatory effect that helps better manage the underlying disease processes.

WHOQOL-BREF scores were higher in the MTX + HCQ group, this indicates that patients on combination therapy experienced greater improvements in overall well-being and functionality. This highlights the potential for better long-term outcomes when HCQ is included in the treatment regimen.

While both treatment groups reported some adverse reactions, the overall incidence was low, with 10% in the combination therapy group and 6.67% in the MTX monotherapy group. Also, there was no statistically significant difference in the rate of adverse events between the 2 groups, suggesting that the addition of HCQ does not substantially increase the risk of side effects. Overall, this study found that combination therapy with MTX and HCQ offers superior outcomes in terms of pain relief, disease activity reduction, inflammation control, and quality of life when compared to MTX monotherapy.

Reference:

Ma, J., Zeng, M., Hsu, C., Li, D., Fok, M. N., Jiang, Y., Li, Q., Ma, J., Zhou, J., Chen, B. S., & Li, F. (2024). Efficacy and safety of methotrexate plus hydroxychloroquine combination therapy vs. methotrexate monotherapy in the treatment of rheumatoid arthritis: A randomized controlled clinical trial. In International Journal of Rheumatic Diseases (Vol. 27, Issue 9). Wiley. https://doi.org/10.1111/1756-185x.15319