instruction: hello doctor my mother is 65 years old she is ra positive for the last 25 years currently she takes hcqs methotrexate pain killer and rantac at present she has pain nodules in hand and turned feet please suggest proper medication her let and kit are normal
output: hi I have gone through your query but the report images could not reveal anything I would like to ask you a few more queries before suggesting the medicine as any new dmard disease modifying antirheumatic drug started has to be taken with caution you mentioned pain is it in the joints or the whole body is there dryness of eyes or mouth is the sleep normal or disturbed any forgetfulness irritability when is the pattern of pain more mornings after waking or constant throughout please message me the dose of folitrax as well which she is taking and the name of the pain killer do you have the last ear erythrocyte sedimentation rate and cop reactive protein is she taking calcium and vitamin supplement I understand she has an aggressive disease considering nodules deformities persisting but lot of times people with long standing arthritis develop secondary fibromyalgia and the management is very different we can only be 100 percent sure after clinical examination but will help you in the best possible way we can try to reattach the reports as well