instruction: hello doctor I have been to six different rheumatologists one of those rheumatologists said I have fibromyalgia and I still do not agree with this diagnosis my labs come back normal my radiographic test concludes osteoarthritis in both knees and thumbs I have pain in these joints and have a bone island in my right knee I am under pain management but I just feel like we are missing something my body feels way off and I am almost positive with seronegative ra I just feel like the physicians are in someway scared to conclude this diagnosis I have bad flares that are bilateral on my hands knees hips and between my shoulder blades I have swelling and fever in these joints I have no idea what to do but I am progressively getting worse please help I am currently taking nucynta er 150 my xanax my lyearica 100 my is tizanidine my and synthroid 25 mug before meals
output: hi you seem to have multiple joint arthritis since cop reactive protein factor anti cop cyclic citrullinated antibody and ear are normal no one is going to conclude this as rheumatoid arthritis or seronegative arthritis I need the following details since how long are you suffering from it do you have an increase in pain and stiffness in the morning when you get up or is it the same throughout the day within how many minutes to hours of getting up in the morning you start feeling lesser stiffness do you have pain and swelling in distal interphalangeal joints of hands