Tony thanks for this input. While there may be a place for HCQ, my point is that I dont know who, and im not willing to try every new RA on the safest but least effective of choices. This is of course my opinion. I think there are many rheums who do use HCQ as you suggest. I tend to be more aggressive because I dont really know who is going to have bad RA in the end, and my first choices are my most important choices. Fred Wolfe said long ago, use your best drug first...I agree with this.