When prescribing hydroxychloroquine, how do you explain the mechanism of action and how this translates into clinical benefit for the patient?

1. Explaining the mechanism of action of hydroxychloroquine (HCQ) when RXing it to a patient:

- Time is limited in clinical practice, and there are SO MANY positive benefits of HCQ that I do not explain the MOA except with the statement:

"HCQ calms down the immune system without actually suppressing the immune system. As opposed to drugs that suppress the immune system and increase infection risks and some cancers, we see fewer infections in our patients who take HCQ than in those who do not, and HCQ may reduce the risk for some cancers, especially skin and breast."

"It is the safest drug we use to calm down the immune system of lupus, and to top it off, it has an amazing number of benefits, including decreasing organ damage/blood clots/heart ...

Dr. @Dr. First Last,

I appreciate your expansive answer concerning autophagy. There is not much discussion in the rheumatology community with respect to the role of autophagy with SLE clinical manifestation and treatment.

There is literature that belimumab decreases autophagy. And since type 1 interferon induces autophagy, it may be that type 1 interferon blockers may inhibit autophagy. But the question remains how does decreasing autophagy on a cellular level improve the clinical manifestations of lupus? Is it possible that autophagy maintains the survival of Treg cells contributing to inflammation? Perhaps inhibiting autophagy results in increased apoptosis of Treg cells contributing to better clinical outcomes.

Another issue is what are ...

Dr. @Dr. First Last,

We know that the immune system has many pathways, but all components work in tandem. It would be a huge misjudgment to focus on only one aspect (autophagy) of the complex immunopathology of a disease like lupus and try to make sense of how to explain it with exercise and fasting, because it is the relative changes, target cells, and the degree of change involved related to autophagy in each condition are different and these cannot be cross-compared only based on the presence of the word “autophagy”.

As for autophagy in lupus and exercise/fasting: in lupus, decreased autophagy of the lymphocytes and antigen-presenting cells contributes to pathogenesis. In exercise and fasting, there is increased autophagy in cells that a...