Hello, She need to reduce weight, screen for autoimmune diseases as she is already on methotrexate. I would like to know why she is on methotrexate and folic acid? ESR is raised as her problem which you haven’t named as uncontrolled (for which she is taking methotrexate and folic acid). C reactive protein is raised due to a mild infection in her body and RBS random blood sugar level is too high secondary to steroids, mild infection and obesity. To reduce ESR increase dose of methotrexate to 7.5mg once a week AND to reduce SUGAR LEVELs, start metformin 500mg (if renal functions are normal) at noon and at night. Check her Echocardiography and renal function tests. Full muscle pain is related to the same problem as that which is causing body swelling and stomach pain is due to naproxen sodium and a lot of drugs. Legs and hand swelling can be cardiac (echocardiography test), nephrogenic (renal function test for kidney) or under-treated thyroid.(not in this case). She should follow diet of avoiding sweet bakery products and normal sugar and others rich in carbohydrates. Surgery will worsen the situation as it will further reduce thyroxin produced naturally. Medicines you are using are the right medicines. thyroid profile is normal. Sugar is raised, Alkaline Phosphatase is normal, Calcium - normal, Phosphorus -normal, C-Rective Protein – mild high, WBC count - 0000 cells/ul (wrong entry ? zero. if zero its very serious), RBC count - normal, Hemoglobin - normal, Hematocrit - normal, MCV – a bit high (need to check levels of folate and vitamin b12), MCH -normal MCHC - platelet count, and differential cell counts are normal ESR – very high Naprosyn 250. It should not be used or minimally used as it causes damage to kidneys. (5 to 7 tablets a month at max) Galvus Met 50mg/500mg should be increased to additional half tablet at night. (if renal functions are deranged), Deevit Soft Gels to be continued as such, Foligem is okay, Folitrax 5MB. (methottrexate) Why this tablet is she using? Tab Rabisure-d containing rabeprazole. Is okay to be used for stomach safety. Glycoment GP 0.5mg glymepride is for sugar control and need to continue. Thyronorm 100MG for throid and a must to continue. Defcort 6mb steroid. Should be slowly tapered off to a minimum as early as possible (another cause of swelling on feet). D-power sachet vitamin D. Should be used for 2 months and thereafter according to advise of specialist. Defcort and naproxen shouldn’t be used for a long time. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Muhammad Faisal Bacha, Internal Medicine Specialist