Everything Old is New Again - From HCQ and Fish Oil in SLE to NSAIDs in RA

When I was in training, we knew every class of NSAID and every possible dose. Fortunately, for current management we have far less need for chronic daily NSAIDs in RA due to better disease control. Years ago, drugs such as celecoxib were demonstrated to provide ACR20 and 50 responses in RA. Etoricoxib (a COX2 NSAID) did not improve DAS28 response in active RA but did meet the co-primary endpoint of pain in a dose-dependent manner (60 mg and 90 mg) (poster #1647).

Hydroxychloroquine has not been licensed in Japan possibly due to concerns about retinal toxicity (although the rates are low; Wolfe database reports a few in 1000 if dosed appropriately at 6.5 mg/kg/d lean body weight). Poster #1782 showed in a double-blind, placebo-controlled RCT that in cutaneous lupus in Japanese patients, active skin lupus improved with treatment as measured by the CLASI. Thankfully it was a positive study because otherwise we (actually I) would then be arguing about study design as a negative outcome would be contrary to what we think about the efficacy of hydroxychloroquine in skin in lupus.

A small trial (poster #1783) showed that fish oil in SLE did not affect disease activity as measured by the SLEDAI but improved inflammatory markers. The study was likely too short and underpowered as there were only 25 patients per group (placebo and fish oil) and a large number of drop-outs despite the trial being relatively short. Fish oil seems to be protective against the development of RA antibodies (anti-CCP and RF) in shared epitope-positive, first-degree relatives of people with RA (poster #2021). This was not the case when the relatives were shared epitope-negative. We also know from an Australian RCT that high-dose fish oil as an add-on to standard DMARDs improves ERA patients in a treat-to-target strategy.

Share This Report

About the Author

Trending Reports From ACR 2015