I am a missionary in the Philippines and had been diagnosed with rheumatoid arthritis a year ago, with severe joint pain in both shoulders and L knee. My labs showed elevated rheumatoid factor and C-reactive protein. After 6 months treatment with methotrexate, I had hives and severe generalized itching, so methotrexate was discontinued and plaquenil begun which also caused itching. But I decided to live with it since my rheumy says that there are no other meds except steroids here to give me. But recently, the itch got severe and constant, and it s been around 9 months since plaquenil was first initiated. With my rheumy s consent, I weaned myself off slowly, and it has been a week since I had any plaquenil. I had been fine through the wean which I took 2 months, until last night, when I experienced pain in my ankle and heel which worsened by noon today. Also last night, my face was warm and red like a sunburn, but I had not been in the sun. It is still red, though not as much tonight. Is this a flare of disease? Should I return to plaquenil treatment, or go on steroids until I get back to the US in a few weeks?