I have been on plaquenil for 6 years for inflammatory arthritis. Recently, it has been feeling like the meds aren t working (fatigue, pain worse). At most recent appointment, my liver and spleen are enlarged, I have a slight thyroid goiter. All bloodwork is ok (no evidence of RA or lupus) but Parvovirus B19 IGG is 4.0 and IGM is 0.1 and EBV IGG AB Quant is 74.7 - but I was hospitalized for mono years ago, so I don t have mono. I am also short of breath. My question is... could this be a chronic viral infection rather than lupus or RA? TSH is normal. Could it still be a thyroid issue even though tests look normal? Also HGB is 15.6 and I am not dehydrated.