Ask the doc about a doublestranddna test dsdna. Hydroxycloroqine should be the first med and has helped me a lot. Good luck and avoid the steroids.
Although Plaquenil was developed and has been used to treat certain infections like Malaria, its use in certain autoimmune diseases is not understood. It can reduce skin problems in lupus and prevent swelling/pain in arthritis-like conditions, though it is not known exactly how the drug works on autoimmune diseases. My guess is that it treats one or more chronic infections that are present.
Arava is a pyrimidine synthesis inhibitor that is used in the treatment of Rheumatoid Arthritis. It is thought to work by blocking certain enzymes responsible for abnormal tissue development or growth.
If you respond to anti-infectives like Plaquenil, you could have a chronic infection like Mycoplasma. These are often found in connective tissue and joint autoimmune conditions.
If you have a Mycoplasma or other chronic infection, then you might respond to anti-infective drugs like oral doxycycline given long-term (These infections are difficult to suppress in the usual short-term courses of treatment that most physicians favor). In cases like this it is usually better to add the additional antibiotic, rather than substituting for the Plaquenil.
Prof. Nicolson