instruction: hello doctor my mother is 43 years old and was diagnosed with rheumatoid arthritis months back her lab reports are as follows serum uric acid 3 my dl of i'm antibody 132 units my her treatment was initiated with defcort 6mg for a week methotrexate 15mg weekly for months hcqs 200 daily post dinner for months it b12 shots weekly for a month followed by b12 shots monthly once even after taking medication for almost months her symptoms of keen pain ankle pain radiating from hip to toe has not seen significant improvement she also took a painkiller named setolacer 300mg which was not useful either I request you to suggest the needful