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Hello Primrose

I'd say the first thing to consider is how the discoid has responded to the Plaquenil. There would usually have been noticeable improvement by now assuming you have been careful about UV exposure.

If you had the other possible symptoms before, are they any better at all?
Is there any increase or are they much the same. Are there any possible new symptoms such as greater fatigue or pleurisy. Some new symptoms such as anemia or new or increased antibodies will only show up in blood tests.
The whole gamut of tests would normally be run plus full blood count and a urine test.
There isn't necessarily any hard and fast distinction between systemic disease and skin disease. People with discoid or subacute skin can have other lupus related symptoms even when they have have no antibodies or enough criteria to be classed as having SLE too Even if they have enough criteria for an SLE diagnosis they might not have any organ involvement The disease is the symptoms that are being experienced and it's those that get treated.

The rheumatologist might think another medicine should be added at this point and you might want to ask him about it. He might say that the Plaquenil should be given more time. In your place I would be keen to try to get the discoid well under control even if it meant adding another medicine like Imuran.
Assuming there are no new findings that would definitely suggest starting on an immunosuppressant such as methotrexate or azathioprine ( Imuran) the best medicine to add could be another anti malarial called Mepacrine in the UK and Quinacrine in the USA. It can be fantastic along with the Plaquenil for skin and other so called 'mild' symptoms.
Unfortunately I haven't heard of it being prescribed in Ireland but Joan may have more definite info. Maybe some NSAID would be enough help with the joint aches and pains, although they aren't disease modifying. It can do no harm to mention it to him.

You need to report all health problems even if you think they probably aren't related to lupus.

Good luck !
Clare
 
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