Female patient of age 30 Chief Complaints Pain joint bilateral hands since 1 year Pain aggregated when she takes Protein rich diet (Serum uric acid normal) History History of taking painkiller since long for same problem she feels relief as soon she takes analgesic. Vitals Bp130/84 Pulse:84 Sp02:98 Afebrile Physical Examination App :Normal Sleep normal Bowel normal Bladder normal Investigations I advice Cbc with crp Ra factor Serum uric acid RA factor positive:40 CRP:28 Sgot/sgpt:60/45 Cbc and kft WNL Diagnosis RA Management Need to be discuss

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D H Q Gold Salts