<s>[INST] What is the first line of treatment for rheumatic arthritis and osteoarthritis? I was diagnosis 5 years ago at age 47, positive rheumatoid factor of 20, sed rates have been 15-20. Problem is in the last 8 months joints in fingers , shoulders and knees are flaring more frequent. So is it time for a biologic? [/INST] Hello, You can consult a rheumatologist and get evaluated. As a first line management you can take analgesics like Tramadol for pain relief. In severe cases you have to start on drugs like Methotrexate. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Shinas Hussain, General & Family Physician </s>