The insurance issue is bs by the way.  Yes there are millions of people out there who have sero-negative RA.  Inflammatory arthritis is an actual disorder but how I interpret all the medical books i have and all the info on the web is that IA is the umbrella term for ongoing pain, swelling and stiffness that they cannot pinpoint.  (in actuality all arthritis isn inflammatory at some point.) What he should have said was that HIS insurance would not allow him to give you the right medications until he makes a diagnoses and he is has not dug far enough yet.  There are guidelines he has to follow to get your insurance to pay for things but with a little paperwork on his part (or by his nurses), things like xrays and such will be approved.  He just has to provide answers when they ask why he wants to do things.  Usually, the right wordage the first time around will get stuff passed.     Now Fibromyalgia can also cause all the same symptoms without the RA factor as well.  However, with things being symetric sounds like RA to me, but keep in mind I am NOT A DOCTOR, I just play one on the computer..hahaha. Have you walked through the website for the American College of Rheumatology?  They are the ones who set up the criteria for diagnoses.    If you are not satisfied with your doctors work, get a second opinion.  In doing so, try not to badmouth your current rheumie because that just causes issues.  Let any doc that you go to know all of your symptoms no matter how small you feel they are.  They need to know to make an acurate diagnoses.  Make a journal so that you can show them in writing your daily or even hourly issues so that you do not forget the little stuff between visits at might mysteriously come and go.    Most of the time first line meds are prednisone, mtx, and/or plaquenil (depending on your response to mtx) and a anti-inflammatory.  From there, they mix and match doses.  Yes alot of our meds tear up your tummy and we take meds for that too.  If you are really not tolerating mtx, ask your doc about Arava.  It usually takes a few months of trial and error and lots of bloodwork results to send to insurance companies.  If nothing is working by the 4-6 month mark, yes you can consider shots.  Enbrel is a good one to start with.    Please don't think you have caused yourself issues by gaining a bit of weight.  That has nothing to do with your hands.  Since you say you do computer work, it wouldn't cause you much knee or hip pain either unless you jog at night.  You cannot do anything to actually cause arthritis.  It causes itself.  It is your inner chemistry.    A lot of doctors will not give painkillers like Vicodine.  You will get familiar with the term, "treat the disease, not the symptoms."  And "if the medication is doing it's job you won't need painkillers."  Alas, I cannot help you with that.  I have a list of ailments as long as my driveway and not a painkiller in the mix.  And I think over 25 years into this, I am past the newbie stage and know when and why something hurt.  But truthfully, when I do get a few painkillers from a sympathetic doc, I tend to hurt myself because of the pain relief.  Nothing like pushing yourself to the point of realizing you have overdone it...LOL..So I do a lot of self massage, breathing and laughing.  Laughing is great medicine.   Let us know whether you can get into another doc.