Hydroxychloroquine and Sjögren Dryness: The JOQUER Result

If you have Sjögren disease and take hydroxychloroquine, ask the rheumatology team which symptoms or disease features the prescription targets. Bring persistent mouth dryness to that discussion and to your dentist.

What JOQUER tested

The French trial randomized 120 adults with primary Sjögren syndrome, including 110 women, to hydroxychloroquine 400 mg/day or placebo for 24 weeks. Recent serious systemic manifestations were excluded. French public funding supported the study; Sanofi supplied the drug and placebo.¹

The primary endpoint required at least 30% improvement in two of three patient-reported scores: dryness, pain and fatigue. With missing values imputed, 10/56 hydroxychloroquine recipients and 11/64 placebo recipients met it. The estimated odds ratio was 1.01 (95% CI 0.37–2.78), without a significant difference.¹

At 24 weeks, dryness scores and unstimulated saliva flow also did not significantly improve versus placebo. The placebo comparison ended at 24 weeks; afterward, both groups received hydroxychloroquine. That extension cannot supply a yearlong placebo-controlled answer.¹

Why a prescription may still have another goal

The BSR guideline, published online in 2024, says clinicians may consider a 6–12-month hydroxychloroquine trial for significant fatigue and systemic symptoms. This is a grade 2C recommendation, drawing on limited evidence. It does not establish hydroxychloroquine as a reliable treatment for mouth dryness.²

Ask the prescriber to identify the intended benefit, how it will be assessed and the review date. Describe dryness separately from aching joints, fatigue or other symptoms. Do not stop or change a prescribed medicine on the basis of this trial summary.

Keep mouth care and medicine monitoring specific

BSR guidance suggests saliva substitutes for oral comfort and emphasizes dental prevention, including fluoride toothpaste and regular dental care. Ask the dentist whether you need additional fluoride or other measures suited to your cavity risk.²

In the US, Plaquenil is labeled for rheumatoid arthritis, lupus and specified malaria uses; Sjögren treatment is off-label. Its label warns about potentially irreversible retinal damage and recommends a baseline eye examination within the first year, followed by monitoring based on risk. Kidney impairment, tamoxifen, dose and duration affect retinal risk.³

The label also warns about serious heart-rhythm problems and interactions with other QT-prolonging medicines. Bring your complete medicine list, kidney history and eye-test dates to the prescribing review. Ask who arranges the next retinal check; an ordinary glasses prescription does not document that screening.³

Is It My Breath? discusses Sjögren disease in “Dry Mouth, Strange Taste,” including coordinated medical and dental care and the additional cavity risks of reduced saliva.