instruction: hello doctor I am a 28 year old female currently under investigation for ra and have been for a while now I began having knee problems at the age of 15 my mothers problems began in her knees at the age of 13 and the problems remained there for a few years in the last three to four years my symptoms have massively progressed to my hands fingers shoulders hips toes and ankles making daily chores quite painful it sounds silly but when the blood tests came back and did show inflammation I was bizarre pleased I had been made to feel like I was over exaggerating a lot so to have it proven was one step in the right direction the private doctor I saw was the one that recommended medication I take celebrex 200 my in the morning with 15 my lansoprazole as previous medication has upset my stomach this medication seemed to be working until eight months ago my blood tests showed my inflammation levels rising again recent stressful situations have I think caused quite a bad flare and I am taking paracetamol more religiously than I would usually small tasks like doing a jigsaw were causing my shoulder to ache I recently got a new set of blood tests done and the results along with results from the last 5 years have been included I would appreciate any advice you can give me I also hand scans of my knees and hips done the scans came back showing effusion in my knees I was told it is nothing to worry about at the moment as the fluid buildup is at a level that could be absorbed back in by the body if it were to get worse though I was told I would need it drained manually my hip scans came back normal but at the time of the scan my hips had only been part of the problem for maybe a year whereas my knees had been bad for the best part of 10 years I am getting frustrated with myself because of my inability to do simple tasks some days I know it is no fault of my own but that does not help when your only 28 and cannot wash the dishes or mop the floor because something will start hurting and I will have to stop I have also progressed quite badly with hand issues I have had occasions where my left wrist and hand will start shaking I have also regularly found myself dropping things like pans cups my cell phone my medication among other things my left side of my body has always been worse than my right side although my right side is slowly catching up I am unsure whether to mention my condition while looking for future work at the moment it is not preventing me from working I have had to occasionally wear braces on my knees or wrists and my current job is aware that if I am sitting down in class it is medically necessary I am aware that compared to some people my inflammation levels when looking purely at bloodwork are very low but the actual pain I am in is very real and I would very much like some advice on how to proceed primarily I am looking for a more effective way to manage my pain levels so I can get back to doing more things typical of a 28 year old rather that sit with a hot water bottle on my back and paracetamol at the ready I have attached a blood tets
output: hi I have gone through your query and blood reports I do have a few queries to help you reach the correct diagnosis I want to be really sure we are dealing with inflammatory arthritis and so we can modify your medicines accordingly as celebrex 200 would not be a solution for a long term do you experience early morning stiffness and swelling if yes for how long are these pains intermittent in nature or persistent how is the sleep pattern do you have early morning fatigue as if you did not sleep well any recent complaints of irritability and forgetfulness any persistent headaches any bowel upsets like increased frequency of stools do let me know these answers because for pain there are many reasons if inflammation is one we should act early