### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I m a 40 year old female who was basically healthy until a few years ago. I m wondering if you can shed any light on what might be going on with me. For the past several years, I ve experienced joint pain symmetrical joint pain in the lumbar spine, sac joints, knees and sometimes ankles and toes. There is no apparent swelling and Osteoarthritis has been ruled out. My thighs and calves often feel fatigued as if I ve run a marathon, when I haven t done anything to cause it. I run low grade fevers off an on, sometimes when I feel well otherwise. I also am tired all the time, sometimes absolutely exhausted. My symptoms flare and tone down. I have headaches as well as migraines. I have started breaking sometimes when I m in the sun. I also get pustules on my skin during the summer which look different from the breaking out in the previous sentence. My hair which has always been very thick is thinning considerably. My BP runs on the high side. My ANA is negative, my sed rate is normal. Drs have noted livedo reticularis, small fiber peripheral neuropathy and macrocytic normochromic anemia, but that s pretty much my different diagnoses, which don t explain most of the symptoms. I have had extensive blood tests. RBC morphology was abnormal (Anisocytosis slight, Poikilocytosis slight, Macrocytes slight) IgG was low, Uric Acid Serum low, Phosphorus Serum low, MCV high, MCH high, MCHC low, RBC Low. I have found the rheumatologists I ve been to aren t very open to possibilities when all the autoimmune diseases are ruled out, even though they do run on my paternal side of the family which consist of RA, Lupus, Takiatsyu s Arteritis, Sjogren s, Polyarteritis Nodosa, Addison s, and Hashimoto s. I would appreciate any expertise you can shed on possibilities to be tested or treated for. I currently have a neurologist 2 hours away and a Rheumatologist in that area as well. My Dr here will likely order any test I request. It seems everything has been ruled out according to my labs, but there has to be something that has been missed or not yet tested for.

### output:

Hihope this msg finds u in good health. I have gone through your complaints and understand your concern. U seem to be having some sort of vitamin or hormonal imbalance which might be causing multiple complaints.  Osteoporosis seems to be more likely that might b causing calcium deficiency in your body.I suggest u get a detailed blood profile done including calcium and magnesium. . Dexa scan for bones. Nothing to worry about. Hope your question has been answered. If u have any follow-up queries, feel free to consult me anytime. Thanks Take care god bless