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Get another doctor.  I'm sorry to be so blunt, but if your doctor is not giving you the kind of care you need, he is not a good doctor for you.   From what you described about your earlier symptoms, the diagnosis of fibromyalgia and chronic fatigue syndrome could be reasonable one - we have a fibromyalgia area in our chronic pain site and you may want to check it out to see how it fits you. However, the rheumatic nodules, the deformities starting in your joints (your toes) and the swelling in your knee are not consistent with fibromyalgia. Joint damage doesn't happen with fibromyalgia, it happens with arthritis and the symptoms you describe should warrant a referral to a rheumatologist even if it's just to cover all the bases and/or cover his rear end. Some doctors rely exclusively on blood tests to show evidence of RA before they will refer or treat and it's an indication of lack of knowledge. Which is okay, as a GP can't be expected to know the ins and outs of all diseases, but in this particular case, it's leaving you in a situation where if you do have RA, you risk permanent damage to joints because your doctor won't do anything. You may consider printing out the article on blood tests I linked to earlier and highlighting the part about how 20 to 30% of people with RA are seronegative or advocating for yourself and asking him for referral despite his belief that you don't have RA. If he continues to refuse, that's the point where you go somewhere else.  By the way, if you're seeing an orthopedic surgeon for your back problem, you may also try to talk to that doctor about this.  An orthopedic surgeon will be able to recognize RA deformities and you may be able to get a referral to a good rheumatologist that way. Sometimes, it's about thinking outside the box and working the system - if one doctor won't take your symptoms seriously, maybe another one well.   Unfortunately, RA can be hard to pin down in the beginning, presenting as other things (e.g., fibromyalgia) and many people end up going from doctor to doctor for quite some time before they get a diagnosis. It's a very rough introduction to self advocacy, but keep listening to your instincts and the messages your body sends you and trust yourself. If you think there's more to it, there probably is, so keep pushing.