Applied Evidence
Beyond chronic pain: How best to treat psychological comorbidities
When chronic pain is accompanied by disturbances in sleep, a psychiatric disorder, or substance misuse, a single agent with multiple symptom...
EVIDENCE-BASED ANSWER:
Hydroxychloroquine and chloroquine improve the arthritis associated with mild systemic lupus erythematosus (SLE)—producing a 50% reduction in arthritis flares and articular involvement—and have few adverse effects (strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCTs]).
Methotrexate reduces arthralgias by as much as 79%, but produces adverse effects in up to 70% of patients (SOR: B, systematic review of RCTs with limited patient-oriented evidence).
Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are often used for SLE joint pain (SOR: C, expert opinion).
Omega-3 fatty acids may reduce arthritis symptoms by about 35% (SOR: B, RCTs with inconsistent evidence).
Abatacept and dehydroepiandrosterone don’t produce clinically meaningful improvements in fatigue associated with SLE, and abatacept causes significant adverse effects (SOR: B, posthoc analysis of a single RCT).
Aerobic exercise may help fatigue (SOR: B, systematic review with inconsistent evidence).
EVIDENCE SUMMARY
A systematic review of pharmacotherapy for joint pain in patients with SLE found 4 poor-quality RCTs that evaluated hydroxychloroquine, chloroquine, and methotrexate.1 Of the 2 studies that examined the effect of hydroxychloroquine, one (47 patients) showed a statistically significant 50% reduction in SLE flares (including arthritis, pleuritis, and cutaneous symptoms) over 24 weeks in patients treated with hydroxychloroquine compared with placebo (TABLE1-8). The second study (71 subjects) found a nonquantified decrease in self-reported pain when hydroxychloroquine was compared with placebo, although some of the patients were also taking prednisone (10 mg/d).
An RCT that evaluated the effect of chloroquine showed a statistically significant reduction in unspecified “articular involvement” compared with placebo.
