instruction: hello doctor I am suffering from chronic gouty arthritis it started ten plus years ago and now progressed to every joint in my body with multiple joint attacks at once I have contact pain in joints even if there is no attack the attacks jump from joint to joint nonstop I have seen many doctors they can only give me shots and prescription of indomethacin which is not working for me as it has been taken for more than 10 years I have changed my diet to exclude a lot of food and drinks with sugar purines citrus salt etc right now the pain is in my ankle knees and left arm shoulder rotator cuff elbow wrist thumb and neck I have been very depressed and go to bed in pain and wake up in pain daily my daily functions are limited
output: hi I have gone through your history and it is a bit unusual for a 40 year old to have polyarticular gout that is involving a lot of joints firstly I would recommend you visit a rheumatologist near you to sort it out meanwhile first we should rule out if it is gout only or some other form of arthritis which are intermittent sorts like gout such as palindromic rheumatism I would like to know your last uric acid levels and if you have ever got rheumatoid factor of and anti cop anti cyclic citrullinated peptide done if it is gout then indomethacin is just going to help the attack you need to start on proper medications the treatment would be to start tablet zycolchine colchicine along with drugs like febuxostat or allopurinol 24 hour urine for uric acid rheumatoid factor anti cop antibody liver function tests kidney function tests palindromic rheumatism zycolchine high fluid intake consult a rheumatologist at the earliest