Brilliant! BUT I have to comment...since entering into Rheumatology in '92 there has been A DRAMATIC CHANGE: in 2018 my patients with RA are not coming in with TKR's, Swan-neck or Boutonniere's, cervical ruffs, vasculitis....so we must be doing "something" right. You're algorithm is "spot on".....for ONE MAJOR REASON: RA = [X] [Y] [Z] / Rx .....BUT the key is: the exponential factor of FM! So I applaud you for this...it remains an essential component. Thank you!