TY - JOUR T1 - Hydroxychloroquine — How Much Is Too Much? JF - The Journal of Rheumatology JO - J Rheumatol SP - 340 LP - 342 DO - 10.3899/jrheum.180639 VL - 46 IS - 4 AU - VANEET KAUR SANDHU AU - MICHAEL H. WEISMAN Y1 - 2019/04/01 UR - http://www.jrheum.org/content/46/4/340.abstract N2 - Although initially approved for medical use in the United States by the Food and Drug Administration in the 1950s, antimalarial treatment of clinical disease actually dates back to the 1630s in Peru, stemming from the “fever tree,” later identified as Cinchona officialis in 1742 by Carl Linnaeus in Europe1. Later, quinine was isolated from Cinchona bark2, yielding the subsequent boom in the development of these agents for the antimalarial market. When the Dutch Cinchona plantations were overrun and captured during World War II, a synthetic version of quinine was created — quinacrine — and was used for malaria prevention, an activity funded and supported by the war effort in the United States3,4. The quinacrine story bears an uncanny similarity to the development of synthetic corticosteroids, which was also supported by the needs of the US government for the war effort during the exact same time period. It was in 1951, after the war was over, that Allied soldiers taking longterm quinacrine demonstrated improved signs and symptoms of systemic lupus erythematosus (SLE)5. Just a few years later (1955), hydroxychloroquine (HCQ) was synthesized, and a successful scale-up created this cornerstone drug for treating SLE. It is now on the World Health Organization list of essential medications needed in a basic health system6.In this issue of The Journal, Tselios, et al … Address correspondence to Dr. V.K. Sandhu, Loma Linda University Medical Center, Rheumatology, 11375 Campus St., Loma Linda, California 92354, USA. E-mail: vksandhu{at}llu.edu ER -