Multicentric reticulohistiocytosis is a rare systemic disease that typically manifests as erosive polyarthritis. The particularly aggressive nature of multicentric reticulohistiocytosis has led many to recommend treatment with high dose corticosteroids, alkylating agents, or both. We describe a 56-year-old woman with erosive polyarthritis successfully treated exclusively for 30 months with hydroxychloroquine and methotrexate. This regimen may have the potential to provide longterm disease control with reduced risk of serious drug related toxicity.