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How an Antimalarial treatment turned to be the gold standard for some rheumatologic conditions.


In this article, we will dive into the topic of hydroxychloroquine (Plaquenil or HCQ) and its significance in the field of rheumatology. Hydroxychloroquine is an anti-malarial drug that gained attention during the COVID-19 pandemic. Although it was found ineffective against COVID-19, it continues to be a valuable treatment option for various rheumatologic conditions. Unfortunately, many patients are unaware of what HCQl is and how it can help them. So, let's explore the key aspects of this medication, including its purpose, usage, and potential side effects.

Understanding Hydroxychloroquine:

Hydroxychloroquine was initially developed as an anti-malarial treatment. However, its effectiveness against malaria has diminished over time, rendering it obsolete for that purpose. Despite its classification as an anti-malarial, HCQl is not immunosuppressive. Instead, it works by rebalancing immune cells at the cellular level, altering the pH levels within the cells. This unique mechanism allows HCQ to modify the immune system without suppressing it entirely, making it an ideal choice for rheumatologic conditions.

Usage and Benefits:

When starting HCQ, it's important to understand that its effects are not immediate. Patience and commitment are key, as it may take up to four months before any noticeable improvements occur. It is advisable to maintain a journal to track symptoms and gauge progress accurately. Hydroxychloroquine has shown positive outcomes in various rheumatologic conditions, including rheumatoid arthritis (RA), lupus, undifferentiated connective tissue disorder (UCTD), and mixed connective tissue disorder (MCTD) to name a few. While it may not lead to full remission on its own, it often plays a pivotal role in managing symptoms and preventing flares.

Benefits in Lupus Treatment:

One of the notable advantages of HCQ is its ability to prevent lupus flares. For individuals with lupus, experiencing a flare can have detrimental effects on vital organs, especially the kidneys. By incorporating HCQ into the treatment plan, rheumatologists can mitigate the risk of flares, thereby safeguarding the overall health and functionality of major organs such as the kidneys.

Important Considerations:

Before starting HCQ, there are a few essential points to bear in mind. Firstly, the most common side effects are mild, such as occasional nausea or vomiting, which usually subside over time. To minimize discomfort, it is recommended to start with a low dosage (one tablet per day) for a week and gradually increase to the prescribed dosage (usually two tablets per day). Secondly, long-term usage of HCQ can cause a cosmetic side effect known as "bronzing" of the skin. Although rare, it is worth mentioning, as some patients may find it concerning. However, this side effect is reversible and often affects only specific areas of the body, like the hands or face.

Rare Side Effects:

While uncommon, it is crucial to be aware of two rare but significant side effects associated with HCQ. Firstly, in patients with G6PD deficiency, HCQ can potentially cause anemia. Regular blood work monitoring can help identify this condition promptly. Secondly, after prolonged usage of more than five years, there is a small risk of retinopathy—a condition affecting the retina that, if left untreated, could lead to vision impairment. Hence, it is standard practice for rheumatologists to recommend an annual eye examination as a precautionary measure.

To summarize:

Hydroxychloroquine is generally a well-tolerated and convenient medication for the treatment of rheumatologic conditions. It offers numerous benefits, particularly in preventing flares in lupus.

Talk with your rheumatologist to learn more about the use of hydroxychloroquine for your needs. If you are looking for a rheumatologist in Colorado, consider our practice and email us at

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