Talk to Rheumatologist on Sero Negative (Undifferentiated) Rheumatoid Arthritis

Dear Doctor, I am Ijaz Maqbool, under follow-up for Undifferentiated (sero-negative) arthritis for the last 10 years. My case has been managed in consultation with Prof. Nighat Hussain Mir, Dr. Rafaqat Hameed, and Dr. Muhammad Faiq. I have cervical spine RA-related changes with pannus formation and C2 involvement, along with disc bulges at C3–C4, C5–C6, C6–C7, and lumbar spine degeneration (L3–S1). I also have confirmed osteoporosis on DEXA scan (lumbar spine T-score -2.8, hip -2.6). Currently I am on Upadacitinib 15 mg daily, Leflunomide 10 mg, steroid taper (Deltacotril), Drate tablet (weekly), along with Lalic, magnesium, Rovista, Evion, ALP, Dolan, and other supportive medications. Despite treatment, I am experiencing increased neck and back pain, stiffness, and difficulty in daily activities. My wife is also RA positive and under treatment for the last 4 years. Kindly review my case and advise regarding treatment adjustment or an early appointment. Regards, Ijaz Maqbool