Oh no. Isn't it terrible how so many times doctors let RA go for so long until it's completely out of control?
In my opinion, more aggressive treatment is immediately needed. Starting a TNF medication such as Humira or Enbrel perhaps. Maybe beginning Imuran and starting Remicade, especially if you have lung nodules and are in the pain that you are.
If you went to the ER, they could at least Rx some steroids, pain meds and even reffer or give a name of a hospital or rheumatologist that can best suite your case.
Better to be on the plaquenil than nothing at all right now. But definitely, DEFINITNELY seek a GOOD practitioner for rheumatics.
Your primary Dr. should be able to Rx prednisone, Imuran, and say Arthrotec and other NSAIDs.
I know too well how painful and life altering rheumatic heart and lung disease is. It's something as you know...we can really do without!
What state are you from? There are hospitals dedicated specifically for bone and joints.
Please, when you feel up to it, write back.
Prayers & good thoughts are with you.