Antimalarials, hydroxychloroquine, and chloroquine are used for musculoskeletal and cutaneous features of Systemic Lupus Erythematosus (SLE) but have additional benefits including prevention of disease flares as well as flares in quiescent disease. Hydroxychloroquine reduces risk of damage accrual in SLE including renal damage. In addition, a beneficial effect on patient survival has been a demonstrated positive effect on lipid profiles with significant reductions in total cholesterol, low density lipoprotein, and triglycerides. Hydroxychloroquine may reduce cardiovascular and thrombotic risk in SLE patients.
It is generally accepted that therapy with an antimalarial should be part of SLE therapy. During the period 2017-2020, in 2404 unique SLE patients, 84.1% were on either chloroquine or hydroxychloroquine. A chart review of those not on the medication showed reasons for no treatment which included side effects (eye toxicity, GI side effects), patient refusal, and long-term remission with drug discontinuation.