For 3 years, i've had a very high +ana (all other negative labs) along with eb and flow episodes of mental and physical fatigue, 3 months of sharp chest pain (now resolved) dizziness, sun-induced rashes, sun sensitivity, joint and muscle pain, nausea,

Difficult to know: ANA is often falsely positive; in fact, if i were to order anas on everyone in the world without assessing for the likelihood of lupus prior to the lab draw, I am more likely to have a false positive than a true positive. Certainly some of your symptoms sound suspicious, but fatigue is seen in many patients and so is non-specific joint and muscle pain. The pattern of your symptoms is the key.

Several options.: I would repeat a reflex ANA to see if you have sjogren's antibodies (ss-a, ss-b). If you have a low white count, elevated immunoglobins, i would err on the side of placing you on hydroxycholoquine. Provigil or nuvigal can help cognitive dysfunction. Use sunscreen for sun-related rashes. Used nsaids or tylenol (acetaminophen) for your pains.