<s>[INST] Hello doctor, I am a 35-year-old male. I am not overweight or flat-footed. For a little while now I have been getting sharp pains on the top of my rib cage, elbows, my left knee and both of my heels. I have a sharp pain in my heels which lasted over a week and could barely walk. There are some days where my entire body aches. These pains come and go. There are times where the simplest task like changing a light bulb will make my arms tired, and walking up steps in my house make me feel like I just ran a marathon. My legs are tired and I am a little out of breath. Again, this does not happen all the time. I have not consulted a doctor yet because the pain comes and goes. My dad has lupus and as far as I know, no one but my father has it. I know your answer will be limited because you have not seen me, but do you think this could be RA? I am currently taking Cymbalta. Any help will be greatly appreciated. [/INST] Hello. The sort of pain you are describing especially the heel one looks more of enthesitis that is the pain due to tendon inflammation. It can happen at various sites like the buttocks, heels, foot, rib area, lower back, and neck. Since none of your joints are involved, it does not look like rheumatoid arthritis. But considering enthesitis inflammation and your age group, it is always advisable to do inflammatory markers like ESR (erythrocyte sedimentation rate), CRP (C-reactive protein) and get tested for HLA B27 (human leucocyte antigen). I am not sure if anti-inflammatory work in your case, but when the pain happens you can try it. Also, check for your vitamin D levels once to be sure the fatigue is not due to its deficiency. Definitely, examination is superior to anything but, at least we can try to rule out serious causes from here. Enthesitis related arthritis. ESR, CRP, HLA B27. Vitamin D deficiency. Enthesitis related arthritis. Anti-inflammatory(Celecoxib during the pain attacks). Vitamin D supplementation. Regular exercises, weight reduction. Do let me know the blood tests when you get it done and also the response of anti-inflammatory. </s>