Q. Other than autoimmune disease, what can cause chronic joint pain?

Answered by
Dr. Naval Mendiratta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 05, 2020

Hello doctor,

I have had many years of health problems including severe joint pain, inability to lose weight, chronic fatigue, transient pains, and abdominal pains that seem to come and go in cycles sometimes lasting for days or even months. I have a medical phobia, so have not been to the doctor unless it was an emergency. But over 20 years ago I ended up going to the ER and had several tests. I was told I had lupus, osteoarthritis, PCOS, and thyroid issues. I have tried to treat myself and pain naturally over the years with a healthy lifestyle and natural aids, but the pain finally became so bad over the last couple of years that I have gone to some appointments.

I was referred to a rhuematologist that did blood work and said I was fine except low vitamin D. I told the new doctor about the early diagnosis and she said it was probably wrong but she would run blood test anyway. When the test results came back, she said I did not have an autoimmune problem and I was fine except that I had low Vitamin D. I have a copy of the test results that look like there are some problems to me and based on her reviews and my personal experience with my health, I would very much like a second opinion. I am taking Xanax when needed. Some tests are attached. I have also had an MRI that showed osteitis pubis, fatty liver, and mild bladder inflammation.



Welcome to

I have gone through your history and blood reports. (attachment removed to protect patient identity).

I found a few abnormalities which I would like to ask a few more details on and also some more questions pertaining to your problem which would help us reach a conclusive diagnosis.

Do you experience any dry eyes or dry mouth? When the pain comes, is it more in the nights or day? Do you experience fatigue in the morning hours as well? Any recent mood changes with irritability? Any history of forgetfulness?

As for the blood test, major abnormalities I found were low vitamin D, positive ANA (but the titer is very low and further ENA is negative) which excludes an autoimmune cause. But your CRP (C-reactive protein) is a bit high at the last report. So there was an infection going on that time or any other symptom as your last CRP was mostly normal.

As of now I do not think you have lupus. My diagnosis is going towards fibromyalgia but would like to confirm after knowing these further queries only.

Thank you doctor,

I have occasional dry eyes and mouth, but not serious. The pain is of varying types, times and cycles. A lot of pain when first standing in the morning (stabbing pain when my feet first make contact with the floor) and in joints (especially ankles and knees) when I stand. I cycle through phases of mild to severe pain, burning and numbness in both hands, and feet, most often at night.

Pain in ankles when not walking that gets more severe without reason while just laying in bed at night and also gets very bad when driving. Other sporadic cycle pains include abdominal pains, all joints stay stiff and painful to some degree. I do not think I am as fatigued in the morning, but I do not do much activity anymore because of the pain levels.

I cannot answer the mood changes very well because I have been working with a therapist for anxiety and PTSD and I have been experiencing different reactions then have been typical for my life, but mostly contained to these interactions with little interactions with others.

Yes, I am on forgetfulness. I have had memory issues to some degree for many years, however, I have become recently worried at an increase in the memory issues and I have begun to have trouble locating words. Also, an increase in other connecting thought processing and memory issues. I did not have any infection going on but seem to have chronic inflammation and my CRP is almost always high. The last blood test a couple of weeks ago has a CRP of 22.3 with a normal range of <8.0.



Welcome back to

Well, there are a few missing spots in your case which I had like to close it on before we can finalize your diagnosis and commence your treatment.

The foot pain you are mentioning looks more of plantar fasciitis or Achilles tendinitis which we can confirm with ultrasound and if positive local injection at that site will help. Just to be sure there is no infection or inflammation for your high CRP. I would recommend to get a whole body MRI (magnetic resonance imaging) or a bone scan which would give us the clue on where the inflammation lies.

Other than that, I think all your symptoms fit in with fibromyalgia. You can read up on it once and we can discuss it further. Body aches, abdominal pain, forgetfulness, all go with it and moreover, it has been troubling you a lot with a normal blood test which again confirms it. I am surprised why no medicines have been given as it is a very nuisance of a disease and can hamper your daily quality of life. Do let me know once you read it and if those tests mentioned above are possible.

Investigations to be done:

1.Whole Body MR and bone scan. 2. Ultrasound of the foot.

Differential diagnosis:


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