A Study of Methotrexate Alone vs HCQ Combination with Methotrexate in DMARD-Naïve Patients with Early Rheumatoid Arthritis

Wajiha  Sarfraz; Zainab  Sarfraz; Umar  Iqbal; Arshaman Ul  Haq

doi:10.54112/bcsrj.v6i6.1835

Authors

Wajiha Sarfraz Combined Military Hospital Lahore, Pakistan
Zainab Sarfraz University of Lahore, Pakistan
Umar Iqbal Department of Orthopaedics, Bahawalpur Teaching Hospital, Bahawalpur, Pakistan
Arshaman Ul Haq Evercare Hospital Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.1835

Keywords:

Arthritis, Rheumatoid, Methotrexate, Hydroxychloroquine, Disease Activity Score, Combination Drug Therapy

Abstract

Early and effective disease control in rheumatoid arthritis (RA) is crucial to prevent joint damage and long-term disability. Methotrexate (MTX) remains the cornerstone DMARD; however, combination therapy with Hydroxychloroquine (HCQ) is often considered to enhance efficacy. Objective: To compare the effectiveness of Methotrexate alone versus a combination of Methotrexate and Hydroxychloroquine in achieving disease control in patients with early RA. Methodology: This quasi-experimental study was conducted at CMH Lahore from October 22 to December 31, 2024. A total of 225 patients with early RA were enrolled and divided into two groups: Group A received Methotrexate monotherapy (15–25 mg/week), and Group B received Methotrexate in combination with Hydroxychloroquine (200–400 mg/day). Disease Activity Score using 28-joint count and ESR (DAS28-ESR) was recorded at baseline and 10 weeks. Results: The mean baseline DAS28-ESR score was comparable between groups (Group A: 5.82 ± 0.91 vs. Group B: 5.87 ± 0.85, p = 0.63). After 10 weeks, a significantly greater reduction in disease activity was observed in the combination group (Group A: 4.12 ± 0.74 vs. Group B: 3.38 ± 0.65, p < 0.001). Remission or low disease activity was achieved in 42.7% of Group A and 64.4% of Group B (p = 0.002). Adverse events were mild and similar between groups. Conclusion: The combination of Methotrexate and Hydroxychloroquine is significantly more effective than Methotrexate alone in reducing disease activity in early RA, with a comparable safety profile. Early combination therapy may provide a more robust and timely response in disease control.

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