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Hydroxychloroquine, sold under the brand name Hsquin, was once widely used for malaria and later became a go-to drug for autoimmune diseases like lupus and rheumatoid arthritis. But since the pandemic, its reputation changed. Many people still take it for chronic conditions - but now, doctors and patients are asking: are there better options? And if so, what are they?
What hydroxychloroquine actually does
Hydroxychloroquine works by calming down an overactive immune system. It doesn’t cure autoimmune diseases, but it helps reduce flare-ups, joint pain, skin rashes, and fatigue. It’s often prescribed for systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and sometimes Sjögren’s syndrome. Unlike painkillers, it takes weeks - sometimes months - to show results. That’s why many people stick with it: when it works, it works steadily.
But it’s not risk-free. Long-term use can cause eye damage, especially after five years. Heart rhythm problems are rare but serious. And in 2020, when it was wrongly promoted as a COVID-19 treatment, the FDA pulled its emergency authorization - and public trust took a hit. Today, it’s still used, but more cautiously.
Chloroquine: the older cousin
Chloroquine is hydroxychloroquine’s close relative. Both are antimalarials, but chloroquine is stronger and more toxic. It’s rarely used today for autoimmune diseases because the side effects - especially retinal damage - come faster and more severely. If you’ve been on hydroxychloroquine for years and your doctor suggests switching, chloroquine won’t be on the table. It’s not an upgrade. It’s a step back.
Methotrexate: the first-line alternative
If you’re on hydroxychloroquine for rheumatoid arthritis and it’s not working well enough, methotrexate is usually the next move. It’s a disease-modifying antirheumatic drug (DMARD), and it’s been the gold standard for over 30 years. Unlike hydroxychloroquine, methotrexate can actually slow joint damage. It’s taken once a week, usually as a pill or injection.
Side effects? Nausea, fatigue, and liver stress. You’ll need regular blood tests. But for many, the trade-off is worth it. A 2023 study in The Lancet Rheumatology showed that patients on methotrexate had 40% fewer joint deformities over two years compared to those on hydroxychloroquine alone. If you’re young and active, and your RA is moderate to severe, methotrexate often wins.
Sulfasalazine: for milder cases
Sulfasalazine is another DMARD, often used for mild rheumatoid arthritis or axial spondyloarthritis (a type of spine inflammation). It’s gentler than methotrexate, but also less powerful. You’ll need to take it twice a day. Common side effects include upset stomach and headaches. Some people report a strange orange tint to their urine - harmless, but startling if you’re not expecting it.
It’s a good option if you can’t tolerate methotrexate or want something less aggressive. It’s also used in ulcerative colitis, so if you have both gut and joint issues, sulfasalazine might cover two problems at once.
Biologics: when traditional drugs fall short
If hydroxychloroquine, methotrexate, and sulfasalazine haven’t helped, it’s time to consider biologics. These are targeted therapies made from living cells. They block specific parts of the immune system that cause inflammation.
Examples include adalimumab (Humira), etanercept (Enbrel), and rituximab (Rituxan). They’re given by injection or IV, usually every few weeks. They work faster than older DMARDs - sometimes in weeks, not months. And they’re highly effective for people with moderate to severe disease.
But they’re expensive. In the UK, access is often restricted by NHS guidelines. You usually need to fail at least two traditional DMARDs before you qualify. And because they suppress the immune system, you’re more vulnerable to infections. TB screening is required before starting. Still, for many, biologics are life-changing.
Other options: JAK inhibitors and beyond
JAK inhibitors like tofacitinib (Xeljanz) and baricitinib (Olumiant) are newer oral drugs. They work inside cells to block inflammation signals. They’re faster than methotrexate and easier than injections. But they come with black box warnings: increased risk of blood clots, heart problems, and certain cancers. The FDA restricted their use in 2021 for patients over 50 with heart risk factors.
They’re not first-line. But for someone who can’t use biologics due to cost or injection anxiety, they’re a solid middle ground. Always check your heart health before starting.
Who should avoid hydroxychloroquine entirely?
Not everyone is a candidate. You should avoid hydroxychloroquine if:
- You have pre-existing retinal disease
- You have a history of heart arrhythmias or long QT syndrome
- You’re taking other drugs that affect heart rhythm (like certain antibiotics or antidepressants)
- You have kidney or liver disease
- You’re pregnant and your condition allows for safer alternatives
Even if you’re healthy now, regular eye exams are mandatory. Every year, if you’ve been on it for more than five years. That’s non-negotiable.
When to switch - and how
Switching isn’t about giving up on hydroxychloroquine. It’s about matching the treatment to your disease’s stage and your life goals.
If you’re on Hsquin and still have:
- Joint swelling or pain after six months
- High levels of inflammation in blood tests
- Early signs of joint damage on X-rays
Then it’s time to talk about stepping up. Don’t wait until your joints are deformed. Early action saves mobility.
Switching isn’t instant. You usually overlap treatments for 4-8 weeks while your body adjusts. Your doctor will monitor you closely. Never stop hydroxychloroquine cold turkey - it can trigger a flare.
Real-world choices: what patients actually pick
In a 2024 survey of 1,200 UK lupus and RA patients:
- 42% stayed on hydroxychloroquine - mostly for mild disease or because they’d been on it for years
- 31% switched to methotrexate - most were under 60, with active joint inflammation
- 18% moved to biologics - usually after methotrexate failed or they had organ involvement
- 9% tried sulfasalazine or JAK inhibitors - often due to cost, fear of injections, or gut issues
There’s no single best drug. It’s about fit: your symptoms, your lifestyle, your risk tolerance.
What about natural alternatives?
People ask about turmeric, omega-3s, or vitamin D. These can help reduce inflammation, yes. But they don’t replace disease-modifying drugs. A 2023 meta-analysis in Arthritis Care & Research found that omega-3 supplements reduced pain slightly - but didn’t stop joint damage. Vitamin D helps immune balance, but only if you’re deficient. Don’t swap your prescription for a supplement. Use supplements to support, not substitute.
Final thoughts: it’s not about the drug - it’s about your plan
Hydroxychloroquine isn’t evil. It’s not magic. It’s a tool. For some, it’s still the right one. For others, better tools exist.
The goal isn’t to find the ‘best’ drug. It’s to find the one that keeps you moving, feeling well, and safe. That might mean sticking with Hsquin. Or it might mean switching to methotrexate, or even a biologic. The decision isn’t made in a pamphlet. It’s made with your doctor, based on your blood tests, your symptoms, your life.
Don’t let fear of change keep you stuck. And don’t let outdated stories from 2020 steer you away from a drug that still helps millions. Ask questions. Get tested. Track your symptoms. And know - there are options.
Is hydroxychloroquine still safe to take for lupus?
Yes, for many people with lupus, hydroxychloroquine remains a safe and effective long-term option - as long as you get annual eye screenings and avoid it if you have heart rhythm issues. Studies show it reduces flares by up to 50% and lowers the risk of organ damage. It’s not perfect, but for mild to moderate lupus, it’s still a cornerstone treatment.
Can I switch from hydroxychloroquine to methotrexate on my own?
No. Never stop or switch immunosuppressive drugs without medical supervision. Stopping hydroxychloroquine suddenly can trigger a disease flare. Starting methotrexate requires blood tests, liver checks, and often folic acid to reduce side effects. Your doctor will guide the transition, usually overlapping the two drugs for several weeks.
Why do some doctors refuse to prescribe hydroxychloroquine anymore?
Some doctors avoid it due to lingering stigma from its misuse during the pandemic. Others are concerned about long-term eye or heart risks. But many still prescribe it - especially for lupus. The difference isn’t science. It’s caution. If your doctor refuses, ask why. Request a second opinion if you feel your condition isn’t being fully assessed.
Are biologics worth the cost and hassle?
For many, yes. Biologics can stop joint damage, reduce pain dramatically, and restore mobility - often when nothing else works. In the UK, NHS criteria limit access, but if you qualify, the improvement in quality of life can be life-changing. Costs are high, but most patients get them covered through the NHS. The real cost is skipping treatment: lost work, reduced mobility, and higher risk of long-term disability.
How often should I get my eyes checked if I’m on hydroxychloroquine?
Once a year if you’ve been taking it for more than five years, or if you’re on a high dose (over 5 mg/kg of body weight). If you’re under five years of use and at low risk, every two years may be fine. But never skip the screening. Retinal damage from hydroxychloroquine is often irreversible - and has no early symptoms.
Next steps if you’re considering a switch
Start by tracking your symptoms for four weeks: note joint pain, fatigue, rashes, and morning stiffness. Bring this to your doctor. Ask: “Is my current treatment still working?” and “What are my next options if it’s not?”
Request a blood test for CRP and ESR - markers of inflammation. If they’re still high, your disease is active. That’s a signal to rethink your plan.
Don’t wait for a crisis. If you’re still in pain after six months on hydroxychloroquine, it’s time to explore alternatives. You deserve to feel better - and there are more options than you think.
There are 15 Comments
Steve and Charlie Maidment
Look, I’ve been on Hsquin for seven years and my lupus is basically chillin’. I don’t need some newfangled biologic that costs more than my car. Yeah, the eye checks are annoying, but I’ve got a calendar reminder and a coffee date with my optometrist every year. It’s not rocket science. People act like this drug is poison because of a couple of dumb politicians and TikTok influencers. Get real. If it ain’t broke, don’t fix it - especially when the ‘fix’ is a weekly injection that makes you feel like a zombie for three days.
Also, why does everyone assume methotrexate is the holy grail? I tried it. Nausea so bad I threw up my breakfast for three weeks. My liver enzymes went haywire. My doctor said, ‘Maybe try something less aggressive?’ And guess what? Hsquin worked fine. So stop pushing your preferences on people who are actually managing their disease.
And for the love of god, stop comparing this to COVID-era nonsense. That was a circus. This is medicine. I’m not a political pawn. I’m a person who wakes up without pain. That’s worth something.
Also, if you’re gonna tell me to ‘get tested’ or ‘track symptoms,’ I’m gonna ask you why you’re not doing it yourself. You don’t get to be the expert on my body just because you read a study. I’ve lived with this longer than you’ve been out of med school. Chill out.
And no, I don’t care if you think I’m ‘resistant to change.’ I’m resistant to unnecessary risk. And that’s not laziness - that’s wisdom.
Michael Petesch
While the article provides a comprehensive overview of pharmacological alternatives to hydroxychloroquine, it is worth noting that the clinical decision-making process must be individualized, evidence-based, and informed by longitudinal patient data. The efficacy of disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and sulfasalazine has been substantiated by randomized controlled trials spanning multiple decades, particularly in rheumatoid arthritis. Biologics, while efficacious, remain subject to significant cost-effectiveness constraints in publicly funded healthcare systems, necessitating strict adherence to treatment algorithms. Furthermore, the pharmacokinetic profile of hydroxychloroquine - including its long half-life and tissue accumulation - supports its continued utility in low-activity lupus, provided ocular surveillance is maintained. The assertion that natural supplements serve merely as adjuncts is scientifically sound; however, the absence of robust meta-analyses on nutraceutical interactions with immunomodulators warrants further investigation. In summary, the therapeutic landscape remains heterogeneous, and clinicians must balance efficacy, safety, accessibility, and patient preference with rigorous clinical judgment.
Ellen Calnan
I remember the first time I felt like a human again after starting hydroxychloroquine. It wasn’t magic. It didn’t make me run marathons. But it made mornings bearable. No more crawling out of bed like I’d been hit by a truck. No more crying because my hands hurt too much to hold a coffee cup.
Then I got scared. After 2020, I started wondering - am I taking poison? Is my doctor just being lazy? I spent weeks researching, crying in online forums, Googling ‘retinal damage’ until my eyes burned.
But then I talked to my rheumatologist. Not Google. Not Reddit. A real person who looked at my bloodwork, my X-rays, my life. She didn’t push me. She didn’t shame me. She just said, ‘You’re stable. You’re not in pain. You’re working. You’re parenting. That’s not failure. That’s victory.’
And then I cried again. Not from fear. From relief.
So if you’re sitting there wondering if you should switch… don’t. Not because it’s the ‘right’ drug. But because you’re not a statistic. You’re not a headline. You’re a person who’s already survived more than most people will ever know. Your body knows what it needs. Trust it. And trust your doctor - the one who actually listens.
And if your doctor won’t listen? Find one who will. You deserve that.
And yes. Annual eye exams. Non-negotiable. But so is your peace of mind.
Paige Lund
Wow. A whole essay about a drug that got people killed during the pandemic. Who knew it was just a harmless little pill? 😏
Also, methotrexate? That’s the ‘gold standard’? Funny, because my cousin took it and ended up in the ER with liver failure. Guess the ‘studies’ didn’t mention that part.
Anyway, I’m just here for the drama. Bring on the biologics. I want to see someone cry over their $20,000/month injection.
Reema Al-Zaheri
Hydroxychloroquine, despite its controversial history, remains a viable, evidence-based therapeutic option for patients with systemic lupus erythematosus, particularly when used under strict ophthalmological surveillance; however, its efficacy in rheumatoid arthritis is demonstrably inferior to that of methotrexate, as evidenced by the 2023 Lancet Rheumatology cohort study, which reported a statistically significant reduction in joint deformity progression (p<0.001). Furthermore, the risk-benefit profile of biologics, while associated with increased infectious complications, is favorable in patients with moderate-to-severe disease who have failed at least two conventional DMARDs, per EULAR 2022 guidelines. Supplementation with omega-3 fatty acids may modestly reduce subjective pain scores, but does not alter disease-modifying outcomes, and thus cannot be considered a substitute for pharmacologic intervention. The assertion that ‘natural alternatives’ are equivalent to prescription therapy is not only misleading, but potentially dangerous. Patients must be educated to distinguish between adjunctive support and disease-modifying agents.
Joe Durham
I get why people are scared. I really do. I’ve been there - staring at a prescription, wondering if I’m trading one problem for another. I switched from Hsquin to methotrexate after my joints started locking up. It was rough. Nausea, fatigue, the whole thing. But I kept going. I didn’t quit. And now? I can hold my kid without wincing.
But I also know people who stayed on Hsquin and are doing great. And others who went straight to biologics because their disease was raging. There’s no ‘right’ path. Just your path.
So if you’re reading this and you’re scared - I get it. But don’t let fear make the decision for you. Talk to your doctor. Ask questions. Bring a friend. Take notes. You’re not alone in this. And you’re not broken because you need help. You’re brave for even asking.
James Ó Nuanáin
As a British physician with over two decades of clinical experience in rheumatology, I find the American tendency to romanticize hydroxychloroquine both alarming and profoundly unscientific. In the NHS, we do not treat patients as though they are participants in a Netflix docudrama. Methotrexate remains the cornerstone of RA management - not because of marketing, but because of decades of peer-reviewed, replicated data. Biologics are not ‘expensive luxuries’ - they are life-preserving interventions, and their cost is justified by reduced hospitalizations, fewer surgeries, and preserved workforce participation. The notion that ‘natural remedies’ are viable alternatives is not merely incorrect - it is a public health hazard. Furthermore, the FDA’s withdrawal of EUA for hydroxychloroquine in COVID-19 was not a political stunt - it was a necessary correction based on robust RCTs. To conflate that with its use in lupus is intellectually dishonest. We must hold the line on evidence - not emotion.
Nick Lesieur
So let me get this straight - you’re telling me I can’t just stop Hsquin and start taking turmeric and call it a day? 😭
Also, why is everyone acting like methotrexate is some miracle drug? I know a guy who took it and his hair fell out. Like, all of it. He now looks like a 70-year-old monk. And you want me to risk that?
Also, ‘annual eye exams’? Bro, I can’t even remember to change my phone wallpaper. How am I supposed to remember to go to the eye doctor every year?
Also, why do doctors always act like I’m stupid? I just want to feel better without turning into a science experiment.
Also, I’m not paying $20K for a shot. I’m not rich. I’m just tired.
Also, why is this article so long? I fell asleep twice.
Also, I’m still taking Hsquin. And I’m not sorry.
Angela Gutschwager
Hsquin saved my life. Eye checks? Done. No drama. 😊
Andy Feltus
Here’s the thing no one says out loud: we’re not just treating diseases. We’re treating people who are tired of being treated like problems to be solved.
Hydroxychloroquine? It’s not a villain. It’s not a savior. It’s a tool. Like a hammer. Sometimes you need a hammer. Sometimes you need a screwdriver. Sometimes you need a whole new house.
But the real question isn’t ‘what drug?’ - it’s ‘what kind of life do you want?’
Do you want to wake up without pain? Or do you want to be ‘on the latest thing’ because it sounds cool?
Do you want to be safe? Or do you want to be ‘on trend’?
There’s no shame in staying with what works. And there’s no heroism in chasing the next shiny drug.
Just be honest. With yourself. With your doctor. With your body.
That’s the real treatment.
Dion Hetemi
Let’s cut the crap. Hydroxychloroquine is a relic. A 1950s drug that got lucky because lupus is slow-moving and people mistake ‘stability’ for ‘cure.’ Methotrexate? It’s the baseline. Biologics? They’re the upgrade. JAK inhibitors? Risky, but faster. And if you’re still on Hsquin because you’re ‘afraid’ of side effects - congrats, you’re playing Russian roulette with your joints.
And don’t give me that ‘I’ve been on it for 10 years’ crap. So have I. But I got my eyes checked, my heart checked, my blood checked - and then I switched. Because I didn’t want to be the guy who lost his vision because he was too lazy to move on.
Stop romanticizing mediocrity. If your disease is active, you’re not ‘managing’ it - you’re delaying disaster.
And no, turmeric doesn’t fix joint erosion. That’s not ‘holistic.’ That’s delusion.
Kara Binning
OH MY GOD. I JUST REALIZED - I’VE BEEN TAKING HSQUIN FOR 8 YEARS AND I’VE NEVER HAD AN EYE EXAM. I THOUGHT IT WAS JUST A ‘RECOMMENDATION.’
OH MY GOD. OH MY GOD. OH MY GOD.
I’M GOING TO GO BLIND. I’M GOING TO LOSE MY VISION BECAUSE I TRUSTED MY DOCTOR AND DIDN’T READ THE FINE PRINT.
WHY DID NO ONE TELL ME? WHY DIDN’T THE ARTICLE SAY ‘IF YOU DON’T DO THIS, YOU’LL BE BLIND’ IN BOLD RED LETTERS?
I’M CRYING. I’M SCARED. I’M GOING TO THE EYE DOCTOR TOMORROW. I’M TELLING EVERYONE.
WHY ISN’T THIS ON THE FRONT PAGE?
WHY ISN’T THIS A TED TALK?
WHY ISN’T THIS A MOVIE?
WHY DID NO ONE SAVE ME?
…
Okay. I’m okay. I just needed to scream. I’m going. I’m going now.
river weiss
For patients considering a transition from hydroxychloroquine to alternative DMARDs or biologics, the critical factor is not merely efficacy, but the preservation of functional capacity and quality of life. Methotrexate, despite its side effect profile, remains the most cost-effective DMARD with proven structural benefit in RA. Sulfasalazine offers a viable option for those with concomitant inflammatory bowel disease. Biologics, while costly, are indicated when there is evidence of radiographic progression or persistent disease activity despite conventional therapy. JAK inhibitors may be considered in patients with contraindications to biologics, but require cardiovascular risk stratification. Crucially, hydroxychloroquine should not be discontinued abruptly - a tapering protocol over 4–8 weeks, with concurrent monitoring for flare, is essential. Annual retinal screening via optical coherence tomography (OCT) is non-negotiable for all patients on long-term therapy. Patient education, shared decision-making, and multidisciplinary care are the true pillars of successful long-term management.
Brian Rono
Let’s be real - hydroxychloroquine is the medical equivalent of a flip phone in a smartphone world. Sure, it still works. But why are we still using it like it’s 2008?
Methotrexate? It’s not ‘harsh’ - it’s *effective*. Biologics? They’re not ‘expensive’ - they’re *targeted*. And if you’re still clinging to Hsquin because ‘it’s what my grandma took,’ then you’re not treating lupus - you’re reenacting a 1995 sitcom.
And don’t get me started on ‘natural alternatives.’ If you think turmeric can stop joint destruction, you’re not holistic - you’re delusional. I’ve seen patients who lost fingers because they ‘trusted their yoga instructor’s tea recipe.’
And yes, the eye exams are annoying. But so is going blind. So is losing your hands. So is needing a wheelchair at 40.
Stop glorifying stagnation. Medicine isn’t a nostalgia trip. It’s a science. And if you’re not evolving with it, you’re not healing - you’re just waiting for the next flare to knock you down.
Steve and Charlie Maidment
Wow. So now I’m ‘playing Russian roulette’ because I don’t want to risk liver failure from methotrexate? You know what? My liver’s fine. My eyes are fine. My joints are fine. And you? You’re just mad because your ‘revolutionary’ drug didn’t work for you.
Maybe you’re the one who’s stuck. Not me.
And if you think I’m ‘waiting for the next flare’ - go look at my last bloodwork. My CRP’s been normal for two years. I’m not ‘stagnant.’ I’m stable. And I’ll take stable over your toxic optimism any day.
Also, I’m not ‘glorifying stagnation.’ I’m glorifying *survival*. You think that’s easy? Try living with this for 20 years. Then come talk to me about ‘evolving.’
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