Hello! Thanks for being with us. Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated. Various treatments are available: Non-pharmacological treatment includes physical therapy, occupational therapy and nutritional therapy but these do not stop the progression of joint destruction. Analgesia (NSAIDs) and anti-inflammatory drugs, including steroids, are used to suppress the symptoms, while disease-modifying antirheumatic drugs (DMARDs) are required to inhibit or halt the underlying immune process and prevent long-term damage. In recent times the newer group of biologicals has increased treatment options. Biologicals like infliximab,rituximab, etanercept, adalimumab, certolizumab,golimumab,interleukin 1 blockers such as anakinra can tried if 3 DMARDs in combination fail to respond. Aceclofenac or indomethacin can be given for pain relief. If her disease was in remission for last year and she was compliant with the medicines,there could be another acute insult like viral fever that could be the reason for normal RF,CRP,ESR,Anti-CCP.Still diagnosis should be reconsidered as these does not correlate with the diagnosis of RA. Osteoarthritis,fibromyalgia can present with severe pain and normal inflammatory markers. Consult with a Rheumatologist for clinical correlation and better management. Hope this could help you.