Well, I don't want to put you off the surgery thing, but long before I learned about diet and autohemotherapy and so forth, I had already had both my wrists operated on, AND my shoulder, the ostensible reason being "arthrosis". My wrists were pretty much ruined by this surgery. The shoulder surgery wasn't so agonizing, but it sure did weaken it a LOT. Now I wish I had known about other therapies before I did those surgeries, because once they get in there and start snipping, scraping, cutting, lasering, there's no going back. The body has an incredible capacity to heal itself if given the right environment and substances.
Since you live in Mexico, perhaps you should look into IV vit C therapy?
I must confess that I have not started hemotherapy for fear that my husband hurt my arm, but days ago I told him to try. My doctor is not currently making IV vitamin C but I am already investigating other places it seems to be expensive.
If there's too much autoimmunity activity affecting the tissues and it's hard to slow down it down despite your best efforts, I would consider mainstream treatment for 3 to 6 months, even if it's just to stop the vicious cycle. If you have a vitamin cocktail in IV, you would have protection from the toxic effects.
Right now I am with Plaquenil 200 mg once a day. I have been 5 months and I have felt good, I have strengthened my legs and my spine with yoga. I have a few days with pain in my knees and a wrist I suspect of some stomach infection because my knees I have felt this before and with kinesiology the doctor told me that it was because of an infection he gave me antibiotics and the pain went away, I'm going to make an appointment with the doctor to see that aspect.
Can you tell us a little bit how your daily life and diet looks like nowadays? We don't have all that much information from your side, especially on recent happenings and developments. Your last post before the above is from 2017. A bit more context would be good. I also think diet could be much more important than you realize.