instruction: hi doctor I am a 45 year old male I had an accident before 10 years at that time my knee ray was done and I was reported to have osteoarthritis I have been suffering from pain for few years I have lower back pain and pain in some of the joints for the past few weeks I have pain in my left palm particularly in my finger joints and more on left middle finger joint also on my foot joints I also feel very fatigued and tired my blood pressure be was 10 70 mhg a week back I am enclosing a comprehensive blood test report which was done very recently and I have advised to take tablet nusam 400 for six months I have been taking for the past two months please suggest me the remedy and preventive measures
output: hi vitamin deficiency and autoimmune cause ultrasound abdomen and pelvis rheumatoid factor mri of spine with sacroiliac joint and mri of the whole spine screening and ultrasound of hands to look for active arthritis hbsag hepatitis surface antigen and hav hepatitis virus seronegative spondyloarthropathy rheumatoid arthritis seronegative spondyloarthropathy calcirol sachets vitamin 600 units once in a week with a glass of water for six weeks and tablet doll 650 my acetaminophen for pain avoid alcohol and excessive weight lifting also try to avoid painkillers as your liver functions are abnormal for further information consult a rheumatologist online