instruction: hello doctor I am a 26 year old female I have joint pain in widespread bilaterally in elbows knees and ankles I also have muscle tenderness on my neck and shoulders and back pain from a herniated disc I take diclofenac 75 my pin for pain I have had laboratory work done and I have seen a rheumatologist my initial labs ana positive 160 speckled cop was elevated my anti is dna cop and ra factor were all negative secondary lab work through elisa showed negative ana and all other autoimmune laboratories were negative except for positive anti phosphatidylserine prothrombim a at units slightly low vitamin but I take supplements I eat a plant based diet and exercise twice a week my other medical history includes depression and anxiety for which I take medication my question is despite my labs being negative why do I still have joint pain and muscles aches
output: hi I would like to ask you a few more queries is your sleep pattern fine morning fatigue how frequently are you taking diclofenac any hair fall oral ulcers dry eyes dry mouth any recent irritability or forgetfulness how much was the level of cop you had mentioned a personal question but is there a particular reason for the depression any family history for endogenous depression there can be many reasons of pain we need to distinguish if it is inflammatory or non inflammatory alone ana positive may not imply much here we have to see if it is impacting your system as well