Compare Hsquin (Hydroxychloroquine) with Alternatives for Autoimmune and Inflammatory Conditions

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.

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.