Ana1:640, intermit low wbc.exten rheum work up all neg even during flares.bad flares >4yrs of fatigue, arthr/myalgia, pleuritic pain, photosen rashes, sicca.rheum tried methotrexate which stopped sx.ctd?

See below: Obviously your doctor felt that you have an active autoimmune when they tried using the medications you mentioned. But beyond that it is hard for me to comment on what exactly you have.

Very likely: Lupus with a secondary sjogrens or a primary sjogrens are most likely. See a rheumatologist if you have not already done so.

Methotrexate: Fatigue, arthralgia, myalgia , pleuritic chest pains , photo sensitivity -rashes and sicca , intermittent low white count with positive ANA 1:640 are all suggestive of auto ommune disease ( connective tissue disease). Rheumatologists do use Methotrexate in conjunction with other drugs as indicated based on clinical features, serology , system involvement, serology and inflammatory markers.