Brief Answer:
You have Pernicious Anemia

Detailed Answer:
Dear XXXX!
I welcome you at my Virtual Clinic. I am Dr. Hanif. I understand your health issues and want to assure you that it will be alright soon. Prognosis of this disease is excellent and its readily treated.
You have Pernicious Anemia that is due to lack of a stomach protein "Intrinsic Factor"(IF). IF is needed for absorption of Vit. B12 and lack of B12 leads to damaged/decreased Red Blood Cells and neuron damage. Numbness and tingling sensations you feel, extreme fatigue, splitting nails are all due to anemia.
My Question is,Who diagnosed it is pernicious anemia, and who prescribed you B12?
If there is evidence for folic acid deficiency but pernicious anemia has not been ruled out, please take both Folic acid and Vit. B12 supplements until pernicious anemia is ruled out. Blood count will improve and you will also be saved from complication of nervous system damage due to B12 deficiency.
When a patient like you comes to my clinic I start her therapy with weekly Cobalamin (Vit. B12.) 1000microgram Intramuscular or subcutaneous injection for 6weeks. After that continuous monthly injections for lifelong mostly.
Please go for Lab Blood work for Complete Blood Count with peripheral Blood film analysis, and, LDH (lactate dehydrogenase levels) after 6 weeks and send me follow up Question for reports to see reticulocyte counts and hemoglobin levels.

Blood transfusion is needed as a last option if the above regimen doesn't work and/or you get neurological symptoms because Cobalamin is necessary for neurons to work properly.

And for wrist issues and thick painful joints of fingers, I normally suggest to take Celecoxib 200mg per oral once daily or divided q12hourly.

Advised Blood Work:-
1. Fasting blood sugar leves?
2. After 6 months some Blood work already written above in my explanation?
3.ANA antibodies?

Hope it helps you. I need you back improved much, with follow up Labs. Respected XXXX, you may contact me anytime you have a question/doubts regarding any health issue.
Regards!

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Brief Answer:
I need further details

Detailed Answer:
I welcome you back dear XXXXX!

I am more than happy to help you as you have genuine health concerns that needs to be addressed. That's why I need further investigation to better assist you. Please go for some Lab tests and come up with the reports:

*Complete metabolic profile
*Serum ferritin levels
*ANA antibodies
*serum uric acid levels
*fasting lipid profile
*Thyroid profile
*fasting blood sugar levels

I will wait for your reply and will try my best to promptly assist you. You may also ask me a direct question at my profile using "Ask me a question" tab; and, add reports of blood work there. Dear XXXX, please don't forget to high star rating this case, and write a feedback to better assist you in future too.

Regards!
Dr. Hanif XXXXXXX USA

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