Rheumatoid arthritis is an unpredictable disease, since it can be dormant for long periods of time or have frequent flares. When flares occur and pain is increased, it is an indication of increased inflammation, and damage can occur. Plaquenil is often supplemented by short courses of prednisone during flares, which addresses the inflammation and reduces damage to the joints. Fatigue is a chronic factor in autoimmune disease, and it is also unpredictable. Allowing for routine adequate rest is helpful both to fatigue and stress on muscles and joints. If the flares increase in frequency, your wife's rheumatologist will likely consider immunosuppressant therapy, or a drug known as methotrexate.
If your wife would like to learn more about rheumatoid arthritis online, looking in Wickipedia is helpful, as it gives a good overview of conditions and often includes information about usual treatment, without the frightening pictures. The Lupus Foundation has information about most autoimmune diseases, including rheumatoid arthritis, and can be accessed online, as can the American Rheumatological Association. If you have any questions that you'd like me to help with, please don't hesitate to ask.
I hope this information is helpful to you. Good luck.
Faye, RN, MSW