When I saw my rheumatologist in early May, I expressed some concern that my lupus was in "active disease mode". I wasn't feeling up to snuff, and I noticed the change immediately when it started getting warmer outside.
I've been on Methotrexate for about a year or so, and that seems to be doing a relatively good job of controlling my rheumatoid arthritis (knock on wood so I don't jinx myself). But lupus is another story.
My rheumatologist said that the only medication change he would consider making was taking me off of Plaquenil (Hydroxychloroquine) - and putting me on Quinacrine - which is known to be more effective in treating lupus. While Quinacrine is in the same class of drugs as Plaquenil, it is no longer commercially available in the United States, and has to be made at a compounding pharmacy (Wallace 2000).
There were some issues with my insurance, and how the drug was made at certain pharmacies, so you may have to do some detective work to make sure that your insurance will cover it, if your doctor ever prescribes Quinacrine for you.
Quinacrine was approved in the 1930s as an anti-malarial. Tests of its effectiveness in lupus (and rheumatoid arthritis) began in the United States in the 1950s, and more recently, Quinacrine has been used to treat those with Creutzfeldt-Jakob Disease, the human form of Mad Cow Disease (so you know this is serious stuff).
Quinacrine is also used as method of non-surgical sterilization in many third world countries. I find this to be a bit disturbing, although in this case, the medication is not taken orally, but is inserted into the uterine cavity in special "pellets".
Then again, Methotrexate was used as an abortion drug in the 1960s, and is sometimes used for that purpose off-label today (National Abortion Federation 2005). And despite this, most people with rheumatoid arthritis are put on Methotrexate for at least some portion of their illness career.
Quinacrine is not effective in those with Central Nervous System (CNS) lupus, but has been known to reduce the headache and fatigue that are common to systemic lupus (Wallace 1989). In comparing Quinacrine to Plaquenil, there is no retinal toxicity, which is one of the major side effects of Plaquenil (Wallace 1989). And Quinacrine takes about two to four weeks to begin working, whereas Plaquenil takes about two to four months. One major side effect of Quinacrine, which isn't present with Plaquenil, is bone marrow suppression, along with skin changes and gastrointestinal problems. Quinacrine is also known not to be as effective in treating synovitis (in arthritis) as Plaquenil. Wallace (1989, 2000) and others (Toubi, et al. 2000) have suggested that Quinacrine is most effective when taken concurrently with Plaquenil, although this is mainly considered when Quinacrine isn't effective on its own.
While Quinacrine does cross the placenta, some have suggested that the concurrent use of Quinacrine during pregnancy is allowable (Wallace 1989), although the effects of Quinacrine during pregnancy remain largely unknown (Toubi, et al. 2000).