Question: I am a 50 year old male. I am wondering what kind of physician consult I might need to make. I am a Registered Nurse.I have bone on bone joint articulation to the knees which after developing caused me to be less active and gain weight,as well as some cardiac deconditioning I am sure.I had to be desensitized to enviornmental allergens back around 2000 as I was allergic to just about everything from trees to dogs and cats,mold dust and so on. I had 2 episodes of pneumonia around 2000,but since the desensitization have not had pneumonia, just periodic asthma flares. My health concern is this. Since about 2008 I have developed cyclical fatigue,as well as increased joint pain during the fatigue spells. During a bad spell i will get TMJ,usually constipated,then diarrhea,oral sores,and gingivitis.Then the symptoms will resolve and I will feel better for 2 to 4 weeks. Lately the fatigue has been lasting longer and more severe,and I have noticed some neurological symptoms. last time my right shoulder became weaker and I had difficulty with fine motor coordination to the right hand making my job more difficult as I still work full time. MRI revealed a little bit of thoracic stenosis but not too remarkable.This time I am in a flare which is resolving but with this episode I had right leg weakness and sciatic pain which is spontaneously resolving.Does this sound like something an immunologist would need to follow or would it be a rheumatology issue? I don't have joint symptoms of RA,just severe osteoarthritis to the knees.My doctor finally kind of gave up and said he believes it is a non-specific auto-immune disorder,and treatment has been symptomatic with steroids NSAIDS neurontin and trazodone,but the flares seem to be getting worse. I am wondering if mine is an isolated case or could it be a lingering effect of the allergies,asthma and subsequent desensitization?Any input would be appreciated. Sincerely, XXXX

I appreciate the suggested lab work.My doctor has not been too aggressive in treating me,but he sees a very high volume of patients and I haven't made it clear enough to him how bad i feel when the symptoms hit. I almost broke down and bought a rolling walker with this last episode due to pain, sciatica and difficulty walking, but I get up a couple of days later and the symptoms are spontaneously resolving.I also get feverish when these episodes hit,not high grade but it is one way I can tell I am going into a flare.A cousin tells me she has similar symptoms,and that our grandmother used to complain of similar symptoms.I have done a lot of reading and don't really have all of the symptoms of any particular thing. I do supplement with vit. D but maybe some sublingual or IM B12 may help, so I will start that, and ask for some lab work with my next Dr visit.I think the diabetes possibility is worth investigating too,as I do have risk factors. Didn't realize it could cause some of the other symptoms you mention,but if it is diabetes left unchecked that would explain the progressive worsening of the immune and neurological symptoms.Anyhow thanks again for your help,and have a great day!