Question: Hi I have had chest and foot, finger and ankle pain for years, it never stops. I seem to have PSA and Gouty Arthritis (there is no break in the flares - it MUST attack something) there is almost always synovial of gouty crystal involvement - but my uric acid can be low and I still have an attack - I now have low IgG and am undergoing replacement therapy for this - what is the best drug for me to treat my constant joint pains - I need to be mindful that I already have immune deficiency, so i need to balance turning off the immune system with my risk of exposure due to low Immunoglobulans? I have tried. Allopurinol, Prednisone (always works), Indocid, Sulphasalazine (doesnt work), Planquil (seems to work), Methotrexate (does not work). I have inflamed lungs and they have become - squamous metaplasia - I just seem to be constantly inflamed ever since I had an Immunization needle I can no longer work as my lungs are damaged - i often get infections and I ALWAYS have joint pain

I dont understand that you say PSA does not come in attacks, it is well documented that PSA has flares... granted I can usually tell the difference between PSA and Gout becasue the Gout comnes on almost overnight and is usually just in the toes - however you can get uncontrolled gout in other places right? I am already seeing Rheumo - however he is quite old, and not up to date with Biologic Treatments - the problem I have is that I dont know which drug or biologic drug is best suited for me - most seem to lower immune response - but I already have a low immune response and they are trying to increase the response because I have low igG - I have intravenous infusons to increase my IgG however this makes the PSA worse. ANA - always seems normal - SLE is negative, So is R Factor Blood Count is usually reasonably ok ESR is usually a bit high CRP is normal unless huge attack, this is even when I have chest wall problems and Gout. I hjave had aspirated jints before and they often find urate crystals, but MRI's suggest more likely to be connective tissue disease as synovial involvement is common - What is Anti CCP antibody - I have not had this tested? What are ILD changes? I have had 6 CT scans due to the squamous metaplasia in my airways and the pain, they never find anything too much wrong - they just see flluid at the bottom of lungs and a lot of inflamation - Biopsies of airways always shows chronic Inflamation of lungs and airways. My whole body seems to suffer inflamation of some kind and has done since immunisation 8 years ago - I am just trying to find a drug that will help with PSA but not affect my already reduced IgG levels? Sulphasalazine seems to lower my IgG even further and I get too many infections