@amykcpa I would not be too worried about that ANA. It is not that high (though level of ANA is supposedly not correlated with severity if illness). It is a signal to see a rheumatologist, for sure, but not cause for alarm.

If your pain is at the 2-3 level you can ask your doc about managing as you have been. You are never "required" to take Plaquenil or any other drug. PT with massage can help a lot, as can things like tai chi, in my experience.

After 20 years of very high ANA, a systemic lupus diagnosis and now scleroderma, my only concern for myself is whether an autoimmune illness is affecting internal organs. Yes we can talk about being proactive and preventative, but many of us have significant test results and symptoms like pain or neuropathy or whatever without any internal damage whatsoever.

Whatever ails you right now may or may not involve internal damage. Your doc can confirm that it is unlikely or not happening at all. Then you can decide on how you want to treat the external symptoms you are having.