Question: Severe Joint Pain, Rashes & Fatigue I'm an IT consultant who spends 10-12 hours with a laptop since last 6 years (No exercise). I quit smoking in Feb - 2013 suddenly (from 1 pack a day to zero). I gained weight (6-7 kg) & since then I started daily exercise (mostly aerobics & yoga) until I observed severe pain in my joints (especially knees & shoulders). I've 3 years of martial-arts/yoga background. Initially I thought it's normal as I just started exercising after 5 years and expected the pain to eventually go away. However, the pain continued and after few days I started getting itchy rashes (similar to hives) in my chest arms, thighs, belly. I started observing that I get these rashes more after bath or exercise (sweat). These rashes are more prominent in skin folds but I also got them in non-skin folds as-well. I've experimented by changing detergent/soap/hot & cold-water/food habit..nothing helped. I also started feeling extremely sleepy and lost motivation and concentration on work. My memory also got affected. My vision also got cloudy/blurred and I got a glass . I had to stop exercising as I felt extremely weak after exercising and severe joint pain. I've been taking a multivitamin and protein supplement everyday since last few years as I was thin and my daily food did not contain much vegetables. I went to doctors and got my blood test done. The only thing identified in the report is raised CRP level . The doctors prescribed jointace, collagen, vitamin d3, gabapentin & hifenacP for few days. I continued it but did not see much improvement. The doctors did not prescribe anything for the fatigue and rashes. I started digging symptoms online and read that it could be an autoimmune disorder. For rashes, initially I found that this might be due to abnormal histamine level/release and inflammation (confirmed by raised CRP level in my blood report). I tried both gen1/2 antihistamine (benadryl/cetrizine) but that made me even more drowsy so I did not continue them. I also found that the rashes look similar to hives & mold allergy. My house do not have proper ventilation and I also saw very little mold in few wet walls in my house. I confirmed with my other family members and they said they also got itchy rashes which goes away by it self in few minutes. This rashes are similar to mine but they do not get as much as I do. Which made me think it might be related to my immune system as I also got joint pain & fatigue. One other thing I noticed that if I scratch or apply pressure to my arm/knees I can see red patches/scratch mark which stays for a while. The fatigue increased and became so bad that I could not even show interest in basic tasks. I doubled my multivitamin capsule (revital/supractiv which contains Gensing) which helped a little but not much. I desperately searched online again and found modafinil ( used for narcolepsy). I read about the side effects & reactions and started with very low dose (10 mg) and gradually increased as I got none of the serious side effects. I'm aware that self-medication could be XXXXXXX but modafinil is the only thing which helped with the fatigue & motivation (My job demands focus and analytical thinking ), although I'm not taking it everyday. I'm good for few hours when I'm on it but the rashes & joint pain remains. I've started mild exercise again since last 30 days. The pain/rashes still do not go away. I feel tired after exercise and the joint pain increases. The fatigue/sleepiness comes back if I'm off modafinil. I don't want to develop a dependency/tolerance on any stimulant. I year back I was very active and focused and now this condition is driving me crazy. It is affecting my work and I'm seeking urgent expert guidance to diagnose and cure this as soon as possible. Currently I'm on the following medication: Multivitamin (1 cap) daily Collagen (10.2 g) daily JointAce (1 cap) daily Vitamin D3 - 1000iu daily Omega 3 fatty acid - 2 caps daily Modafinil 50mg - alternate days WheyProtien - alternate days Similar Rash Images: WWW.WWWW.WW WWW.WWWW.WW My questions: Looking at the symptoms, could it be autoimmune disorder ? Is quitting smoking related to this ? (i.e. Hyperthyroidism) Could it be related to arthritis ? (RA factor was normal in the report though ) I don't want pain killers or stimulants to suppress the symptoms. To find the root cause, where should I start ? Raised CRP level is an indication of inflammation. How do I find out what's causing it ? I did the blood test in May 2013. What further tests are required for proper diagnosis ?

Hello Sujoy, Thanks for the detailed answer. I'll get all the tests tomorrow and get back to you with the reports. Based on the results we'll further discuss the possible treatment options. Thanks & Regards, XXXXX

Hello Sujoy, I've uploaded the reports. Please find attached and suggest the next plan of action. The only one test missing is Mast cell tryptase, which will take more than a month as the sample has to be sent to the US and would cost around 8k. Please let me know if this test is still required. I've started Levocetirizine and Fexofenadine and will include Montelukast in a day or two.

Hey Sujoy, Please try this alternative download link for the reports (zipped): WWW.WWWW.WW Please let me know if it does not work.

Thanks much for the quick answer but I'm a little bit confused. So here are few quick questions to clear my doubts: Could you please summarize underlying root cause linking it to the symptoms ? What I currently understand is cholesterol level is high, vitamin D3 is level insufficient and rashes are because of ucitaria(hive) and abnormal histamine release. How can I control the fatigue and excessive sleepiness during day time? Should I continue modafinil/multivitamin or you have a better recommendation ? **This is really important as it is affecting my productivity and work performance. Should I continue exercise ? How should I control the joint pain & tiredness following it? Is it likely to reduce with the current medication or I need to take painkillers? **Exercise is making me worse, affecting my productivity. Should I continue jointAce (glucosamine chondroitin) and Collagen ? I'm already taking uprise d3 1k iu daily, so if I got it right, I need to stop that and make it 60K iu once in a week, correct ? Adding a missed question: I've also noticed increased production of thick nasal mucus causing trouble breathing sometimes. Could it be related ? (looking at the relatively high Eosinophil)

Thanks again Sujoy. I'll follow your advice and update you on the improvements after few weeks. Closing the discussion for now. Thanks again for your time, really appreciate it.