Brief Answer:
Consultation

Detailed Answer:
Hi XXXX, thanks for asking from HCM.


I can understand your concern. You are having multiple diseases at same time which are related to each other. In our body, a vicious cycle starts whenever we suffer from chronic illness. This vicious cycle leads to origin of new diseases. Like in your case, the presence of RA which lead to joint pain/drug intake and its side effects, which might have lead to stomach upset/mental and physical distress, which lead to anxiety and depression.

I am telling you all this because if we treat each disease separately, you will lend up in taking multiple medications, which may cause more side effects.
Your treatment requires control of RA and fibromyalgia symptoms first. As you have mentioned - RA is not active currently, it is the Fibromyalgia, which is causing pain. It needs to be controlled by

: Simple painkiller like Paracetamol after proper prescription.
: You can take antidepressants like Amitriptyline or Duloxetine/Venlafaxine after proper prescription. These drug will treat your depression. However they can cause some side effects.
: You can take Pregabaline or Gabapentine after proper prescription. They can be taken only if you develop side effects of antidepressants.
: Physiotherapy, acupuncture therapy

You have to consult doctor for it.
After getting some relief in fibromyalgia, you will get some relief in overall stress and that will lead to some improvement in depression and anxiety. It can be further treated by

: Counselling and behavioural therapy - Consult Psychiatrist for it.
: Yoga and meditation - You need to practice it. It will relieve you stress, muscular and joint pain, normalise BP. It takes time, but once you started it, you will see improvement definitely.
: Antidepressants as mentioned above.
: For anxiety, you can take Clonazepam after proper prescription. It will also treat sudden BP spike due to stress, will give relief in constant nausea/chest tightness or pain/hot flashes by treating anxiety.

Gradual control over depression and anxiety will lead to relief in stomach trouble. However if still no relief, you can take

: Tablet Pantoprazole after proper prescription.
: Syrup Magnesium-Aluminium hydroxide after proper prescription. It should be taken after every meal.

Regarding flu like symptoms, if it is still persistent, get investigation to rule out chronic infection or inflammation.
: Total leucocyte and differential leucocyte count
: Blood culture if persistent fever
: Chest X ray if presence of cough/sputum/sharp chest pain.

If it is not infection, it could be side effects of drugs which you were taking or due to psychological stress. It can be managed by

: Tab Paractemaol in case of presence of fever.
: Application of cold compresses if fever still persistent after paracetamol.
: Rest
: Control of depression and anxiety as mentioned above
: Bed rest
If still no relief, consult rheumatologist regarding relation between it and RA. Further treatment will be given after confirmation.

Heat flushes could be due to
: Prost-Menaupausal symptom
: Anxiety
: Drug side effect

You can wait and observe whether you are getting relief in it after getting relief in anxiety. If not, consult gynaecologist for it and possibility of
: Starting hormone replacement therapy to control it.

Hope it will help you. If still in doubt, do let me know. I would be happy to help you.

Thanks. Take care.

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Brief Answer:
Thank you

Detailed Answer:
Hi XXXX, thank you very much for the appreciation.

I would be happy to help you in future if you will be having any doubt.

Take care.

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