Autoimmune Treatment Comparison Tool

Compare Your Treatment Options

Select your condition and symptoms to see how hydroxychloroquine compares with alternatives.

Hydroxychloroquine, sold under the brand name Hsquin, was once widely used for malaria and later became a go-to drug for lupus and rheumatoid arthritis. But since 2020, its reputation has shifted dramatically. While some still rely on it, many doctors now consider it outdated or risky for long-term use. If you’re taking Hsquin or were prescribed it, you’re probably wondering: are there better, safer options?

What hydroxychloroquine actually does

Hydroxychloroquine is an antimalarial drug that also has immune-modulating effects. It works by interfering with how immune cells process signals, which reduces inflammation. That’s why it was prescribed for autoimmune diseases like systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). It doesn’t cure these conditions, but it helps control flares, reduces joint pain, and can lower the need for steroids.

But here’s the catch: it doesn’t work for everyone. Studies show only about 50-60% of lupus patients get meaningful relief. And for rheumatoid arthritis, it’s usually combined with other drugs like methotrexate because it’s too weak on its own.

Worse, long-term use carries real risks. Retinal damage can happen after five years of daily use - and it’s often irreversible. The FDA issued a black box warning in 2020 about heart rhythm problems, especially when taken with azithromycin or in people with kidney or liver disease. In 2023, the American College of Rheumatology stopped recommending hydroxychloroquine as a first-line treatment for RA.

Alternative 1: Methotrexate - the gold standard

If you’re looking for the most proven alternative to hydroxychloroquine, methotrexate is it. It’s been used for over 40 years in rheumatoid arthritis and is still the most common first-line DMARD (disease-modifying antirheumatic drug). Unlike hydroxychloroquine, methotrexate actually slows joint damage and reduces long-term disability.

It’s taken once a week, not daily. Side effects include nausea, fatigue, and liver stress - but these are manageable with folic acid supplements and regular blood tests. The risk of serious infection is low if monitored properly. For lupus patients, methotrexate is often used when hydroxychloroquine isn’t enough, especially for skin and joint symptoms.

It’s not perfect - some people can’t tolerate it - but for most, it’s far more effective than Hsquin. A 2022 study in Arthritis & Rheumatology showed methotrexate reduced disease activity by 40% more than hydroxychloroquine in RA patients over 12 months.

Alternative 2: Sulfasalazine - gentle but effective

Sulfasalazine is another older DMARD, often used for mild to moderate rheumatoid arthritis and sometimes for lupus-related arthritis. It’s less powerful than methotrexate but gentler on the body. Many patients tolerate it well, even those who get nauseous from other drugs.

It works by reducing inflammation in the joints and gut. That’s why it’s also used for ulcerative colitis. Side effects include upset stomach, headaches, and a rare but serious drop in white blood cells. Regular blood work is needed, just like with methotrexate.

It’s not a replacement for hydroxychloroquine in skin or organ involvement in lupus, but for joint pain alone, it’s a solid, low-cost option. In Scotland’s NHS, sulfasalazine is still commonly prescribed as a starter drug because it’s affordable and has a long safety record.

A hand placing hydroxychloroquine into recycling as methotrexate is delivered, with holographic health monitors glowing nearby.

Alternative 3: Biologics - when older drugs fail

If methotrexate and sulfasalazine don’t work, or if your disease is aggressive, biologics are the next step. These are targeted therapies that block specific parts of the immune system causing inflammation.

Examples include adalimumab (Humira), etanercept (Enbrel), and rituximab (Rituxan). They’re given by injection or IV, not pills. They work faster than traditional DMARDs - often within weeks - and can put disease into remission.

But they come with trade-offs. They’re expensive (costing £10,000-£20,000 per year in the UK), and they increase the risk of serious infections like tuberculosis or fungal infections. You’ll need screening before starting. In 2024, NHS guidelines began approving biologics earlier for patients with high disease activity, even if they’ve only tried one traditional DMARD.

For lupus patients, belimumab (Benlysta) is the only FDA-approved biologic. It’s not a cure, but it reduces flares by nearly 30% in clinical trials. It’s usually reserved for patients who can’t tolerate hydroxychloroquine or who have severe kidney involvement.

Alternative 4: Hydroxychloroquine alternatives for skin and mild lupus

If your main issue is skin rashes or mild joint pain from lupus, hydroxychloroquine isn’t the only option. Topical treatments like corticosteroid creams or calcineurin inhibitors (tacrolimus) can help localized rashes without systemic side effects.

For persistent discoid lupus lesions, antimalarials like chloroquine (a cousin of hydroxychloroquine) were once used - but it carries even higher retinal risk. Today, doctors are turning to low-dose thalidomide or mycophenolate mofetil for stubborn skin disease.

Some patients also benefit from phototherapy (UV light treatment), especially in spring and summer. A 2023 trial at Aberdeen Royal Infirmary showed 70% of lupus patients with skin symptoms improved after 12 weeks of narrowband UVB therapy, with no systemic side effects.

What about natural alternatives?

You’ll find plenty of online claims about turmeric, fish oil, or vitamin D replacing hydroxychloroquine. While these can support overall health, they don’t stop autoimmune damage.

Vitamin D deficiency is common in lupus patients, and correcting it helps with fatigue and bone health. Omega-3s from fish oil may slightly reduce inflammation, but they don’t prevent joint erosion. Turmeric (curcumin) has shown promise in lab studies, but human trials are small and inconsistent.

None of these can replace a prescribed DMARD. Relying on supplements alone can lead to irreversible organ damage. Always talk to your rheumatologist before stopping hydroxychloroquine.

A fragmented autoimmune flare mech attacked by four crystalline alternative mechs in a neon-lit hospital with glowing energy beams.

When to consider switching

You should consider switching from hydroxychloroquine if:

  • You’ve been on it for more than 5 years without a clear benefit
  • You’ve had an eye exam showing early retinal changes
  • Your symptoms are getting worse despite taking it
  • You’re on other medications that increase heart rhythm risks (like antibiotics or antidepressants)
  • You’re pregnant or planning pregnancy - hydroxychloroquine is still considered safe in pregnancy, but alternatives like sulfasalazine are preferred if possible

Never stop hydroxychloroquine suddenly. It can trigger a flare. Always taper under medical supervision.

How to talk to your doctor about alternatives

Bring a list of your symptoms and how they’ve changed over the past year. Ask:

  • "Is my current dose still helping, or is it just keeping me from flaring?"
  • "What are the risks of continuing vs. switching?"
  • "Are there any new guidelines I should know about?"
  • "Can we try a different DMARD before moving to biologics?"

Doctors are more open to change now than they were in 2020. Many are actively weaning patients off hydroxychloroquine unless there’s a strong reason to keep it.

Is hydroxychloroquine still used at all?

Yes, but only in specific cases. It’s still sometimes used for mild lupus with skin or joint symptoms, especially if other drugs aren’t tolerated. It’s also occasionally used for Sjögren’s syndrome or certain forms of chronic fatigue linked to autoimmune activity. However, it’s no longer a first-choice drug for rheumatoid arthritis or severe lupus.

Can I switch from hydroxychloroquine to methotrexate safely?

Yes, and it’s often recommended. Doctors typically start methotrexate while slowly reducing hydroxychloroquine over 4-6 weeks. Blood tests are done before and after to monitor liver and kidney function. Most patients transition without flares, especially if their disease is stable.

Do any alternatives cause less eye damage?

Yes. Methotrexate, sulfasalazine, and biologics do not carry the same risk of retinal toxicity as hydroxychloroquine. That’s one of the biggest reasons to switch. Annual eye exams are no longer needed if you stop hydroxychloroquine and switch to a safer alternative.

Are biologics worth the cost?

For many, yes. While expensive, biologics can prevent hospitalizations, joint replacements, and work disability. In the UK, NHS prescribes them based on disease severity, not just cost. If your condition is active and other drugs failed, you’re likely eligible. Some patients report feeling like they’ve gotten their life back after starting a biologic.

What happens if I stop hydroxychloroquine and have a flare?

Flares can happen, but they’re usually milder if you transition slowly and under supervision. Your doctor may temporarily increase steroid doses or add a short course of another DMARD. Most flares respond quickly to adjustment. Waiting too long to switch - because you’re afraid of flares - is riskier than switching.

Final thoughts

Hydroxychloroquine isn’t a villain - it helped millions for decades. But medicine has moved on. We now have safer, more effective tools. If you’re still on Hsquin, ask your doctor if it’s still the right choice for you. You deserve a treatment that works without risking your vision or heart. The alternatives exist. The evidence is clear. It’s time to update your plan.