The pain from chronic infection can be referred to joints, and the location of joint pain can be a clue to the nature of the infection. Multiple types of metabolically active chlamydia pathogens have been identified in fluid around arthritic joints. Blocked arteries, cardiovascular events, gastrointestinal disease, liver disease, gallbladder disease, pancreatic disease, kidney disease, reproductive disease, and bladder/urinary tract disease can all be caused by chronic infection and refer pain to the back. Throat and respiratory infection can refer pain to the head, neck, TMJ, shoulders, and back. Urine infection can refer pain to the knees or hips.

Diagnosis of immortal pathogens in patients with arthritis will aid in determining the root cause of the patients’ pain.