When I got with my good rheumie, we spent about 14 months going through all the NSAIDs (had already done plaquenil, sulfasalzine, and asacol and had some benefit from them, but too many side-effects).
Since my symptoms responded to NSAIDs, but I wasn't getting enough relief, and too many side-effects, that is when my rheumie put me on Enbrel. He felt the positive response to all these meds meant it was a generalized inflammatory arthritis condition - not much in blood results, b27-, and nothing on scans.
His instinct was correct and Enbrel gave me my life back.
My initial years of symptoms were primarily fatigue and then joint pain in hands/shoulders. The spine and SI pain developed later. Currently, my SI and my feet and lower legs are my worst areas.
I need Enbrel, Indomethacin(this is by far the most effective NSAID I've ever been on), Imuran, methotrexate, and morphine to keep the disease and pain under control.... and despite all these, it has still continued to progress slowly all these years.