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Wow, you do have more than your share of problems. I'm so sorry you're going through such a rough time. Much as I wish I could wave a magic wand that would make it all go away, I can't. And I'm not sure I have any medical advice that will be very helpful. Do you have a rheumatologist? Did s/he say you have RA? A fair number of people who have the disease can have a negative RA factor, so don't get too hung up on the numbers.   I think any advice I can give you would center on coping mechanisms. You already know that losing weight will help you, not just in terms of the pain, but also for the COPD. But I know that this is easier said than done, as losing weight when you have physical limitations is very difficult. You're already going to the health club and that's great - keeping as active as possible will be good for your body and your spirit. Have you spoken with your doctor about assistance with losing weight? There might be something they can do to help you. And the smoking... well, you know that, too. Smoking is no good in general, but when you have asthma and COPD, it's definitely not good. I used to smoke, so I can relate to why you're doing it, but in your situation, it's very self-destructive. I can understand that in your situation you may be very angry at your body, but you only have that one body and it needs all the help you can give it to get you through the day.   Have you considered counseling? You have an awful lot on your plate and speaking to a therapist could be helpful. I saw a shrink for several years when I was having problems dealing with a number of health issues and although it didn't make the medical problems go away, going to counseling taught me ways of coping, helped me to reduce the muddle and get a clearer picture. And by getting that clearer picture, I was able to target where I needed to be an advocate for myself in the medical field and found better treatment.   I'm so sorry I can't be of more help and wish you much luck. Please know that I'm thinking of you.