The treatments that are offered at a rheumatologist are all very
serious. Compared to them, the Plaquenil is the least toxic.

But compared to OTHER drugs the medical arena has (except for chemo drugs) for many other conditions, it is quite toxic.

So the rheumies would try their least toxic regimen first, and that would be Plaquenil.

So it becomes a matter of degree, and understanding that rheumatology is rather unique. Plaquenil also has some disease modifying potential whereas a symptom relieving drug like gabapentin, does not. Doctors are used to "managing" treatments but some are better than others. Also not all patients are perceptive enough to communicate with doctors (my husband is one of this type) and so a serious side effect may be missed by a this kind of patient.