Autoimmune and inflammatory disorders can create pain that goes beyond one joint, muscle, or injury. At Manhattan Pain Medicine, we evaluate how immune dysregulation, systemic inflammation, connective tissue changes, post-infectious syndromes, and nervous system sensitization may contribute to chronic pain, flare patterns, fatigue, stiffness, and impaired healing.
Autoimmune and inflammatory disorders can cause pain throughout the body. Dr. Nino explains the connection and what you can do about it.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Nino Mikaberidze, and I’m a rheumatologist at Manhattan Pain Medicine. I’d like to talk about one of our Zones of Expertise: Autoimmune and Inflammatory Disorders.
Inflammation is something we actually need. It’s part of how the body heals and protects itself. But in some cases, that system becomes overactive or dysregulated, and instead of helping, it starts to cause symptoms.
This is what we see in autoimmune conditions, like lupus or psoriatic disease, as well as in post-infectious states, such as after Lyme, Epstein-Barr virus, or COVID. It can also show up in forms of immune dysfunction, like mast cell activation.
What makes these conditions challenging is that they often affect multiple systems at once. Patients may experience pain, fatigue, inflammation, or symptoms that feel widespread and difficult to connect.
Over time, this kind of persistent inflammation can also sensitize the nervous system, making pain feel more intense, and in some cases, it can even affect joint stability and movement patterns. That’s why our approach is very structured.
We begin with discovery, taking the time to understand what’s driving the inflammation and how it’s affecting your body. From there, we move into treatment, where we focus on calming that overactive response while also helping manage pain and improve function. And then maintenance, where the goal is to help you stay stable, reduce flares, and feel more in control of your symptoms over time.
These conditions can feel overwhelming, but with the right evaluation and a coordinated plan, they are often very manageable.
If you’ve been dealing with symptoms that feel persistent, systemic, or hard to explain, this may be an area worth exploring.
Inflammation is a normal part of healing. It helps the body respond to injury, infection, and stress. But when the immune system becomes dysregulated, inflammation can become excessive, persistent, or misdirected.
This can happen in autoimmune conditions such as rheumatoid arthritis, lupus, psoriatic arthritis, Sjögren’s syndrome, vasculitis, and ankylosing spondylitis. It can also occur after infections such as Lyme disease, Epstein-Barr virus, or COVID, or in overlapping conditions involving mast cell activation, small fiber neuropathy, hypermobility, and chronic pain sensitization.
At Manhattan Pain Medicine, we look at autoimmune and inflammatory pain as part of a larger system. The goal is to understand what is driving the inflammation, how it is affecting the tissues and nervous system, and what needs to be treated first so the body can respond more effectively.
Autoimmune and inflammatory pain often requires collaboration across rheumatology, pain medicine, rehabilitation, pain psychology, and other clinical perspectives. At Manhattan Pain Medicine, care is coordinated around the patient’s full presentation, including symptoms, lab findings, imaging, physical examination, treatment response, and the broader pain pattern.
Patients may benefit from evaluation when pain is associated with prolonged morning stiffness, unexplained swelling, fatigue, brain fog, heat or redness around joints, flares after minor strain, symptoms after infection, hypermobility-related instability, or pain that feels body-wide rather than purely mechanical.
In autoimmune and inflammatory pain, treatment order matters. If systemic inflammation is active, the body may overreact to mechanical strain, procedures, or even normal tissue stress. We work to identify and calm the inflammatory driver first, then address the structural, neurologic, or rehabilitation needs that remain.
Your evaluation may include a detailed review of pain patterns, morning stiffness, swelling, fatigue, flare triggers, prior lab results, imaging, medication response, and family or infection history. When appropriate, the team may use advanced imaging, musculoskeletal ultrasound, targeted medication trials, or diagnostic injections to help determine whether inflammation is contributing to the pain.
Inflammation can amplify pain, sensitize nerves, weaken connective tissue, and make the body more reactive to strain or procedures. Understanding whether inflammation is active helps determine which treatments should come first and which treatments may need to wait until the system is more stable.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Yes. Autoimmune disease can cause chronic pain by creating persistent inflammation in joints, tendons, ligaments, connective tissue, nerves, or surrounding soft tissues. Inflammation can also sensitize the nervous system, making pain feel more widespread or more intense than the visible tissue findings alone might suggest.
Inflammatory pain often includes prolonged morning stiffness, swelling, warmth, pain that improves with movement, flares after rest, fatigue, brain fog, and symptoms that feel more systemic than purely mechanical. Some patients also notice that minor strain creates a much larger pain flare than expected.
Yes. Some inflammatory or autoimmune conditions can be seronegative, meaning standard blood markers may appear normal even when symptoms, physical examination, ultrasound, MRI, or medication response suggest active inflammation. This is why evaluation should include the full clinical picture, not labs alone.
Enthesitis is inflammation where tendons or ligaments attach to bone. It is common in conditions such as psoriatic arthritis and other spondyloarthropathies. Enthesitis can cause deep, focal pain around areas such as the heel, pelvis, spine, ribs, or sacroiliac region.
In patients with hypermobility, joints and connective tissues may already be more vulnerable to strain. If inflammation is also active, the immune system may overreact to minor mechanical stress, creating larger flares, more tissue sensitivity, and difficulty healing. In some cases, inflammation may also contribute to worsening laxity or instability.
Regenerative treatments such as prolotherapy or platelet-rich plasma rely on a controlled healing response. If autoimmune or inflammatory activity is uncontrolled, the body may overreact to that stimulus and create a severe flare. At MPM, we work to identify and control systemic inflammation first so structural treatments can be considered more safely and thoughtfully.
Evaluation may include a detailed history, physical examination, lab testing, review of symptoms such as morning stiffness and fatigue, musculoskeletal ultrasound, MRI, medication response, and targeted diagnostic injections. The goal is to determine whether inflammation is a primary driver, a secondary amplifier, or part of a larger overlapping pain pattern.
Treatment depends on the diagnosis and severity of inflammation. Care may include anti-inflammatory medication trials, disease-modifying antirheumatic drugs, biologic therapies, low-dose naltrexone, IVIG in selected cases, targeted injections, rehabilitation, pain psychology, and coordinated pain management.
Yes. Some patients develop persistent inflammatory or immune-related symptoms after infections such as Lyme disease, Epstein-Barr virus, or COVID. These post-infectious states may contribute to pain, fatigue, brain fog, autonomic symptoms, and nervous system sensitization.
MPM evaluates autoimmune and inflammatory pain as part of a larger system. We look at inflammation, connective tissue stability, nerve sensitivity, dysautonomia, mast cell activation, movement patterns, and pain sensitization together. This helps the team determine what needs to be treated first and how each part of the pain picture fits together.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If pain is associated with morning stiffness, swelling, fatigue, flare patterns, hypermobility, post-infectious symptoms, or unexplained systemic inflammation, our team can help evaluate whether autoimmune or inflammatory drivers may be contributing and guide the next step in care.
Autoimmune and inflammatory disorders occur when the immune system becomes dysregulated and creates inflammation that is excessive, persistent, or misdirected. Inflammation is part of normal healing, but when it stays active or attacks the wrong tissues, it can create pain, stiffness, fatigue, tissue irritation, and nervous system sensitization.
At Manhattan Pain Medicine, we evaluate autoimmune and inflammatory pain as part of the full clinical picture. The question is not simply whether a patient has a named autoimmune diagnosis. The question is whether inflammation is contributing to pain, impairing healing, amplifying the nervous system, or changing the order in which treatment should happen.
Inflammation can change the behavior of tissues and nerves. Inflamed tissue releases chemical mediators that make surrounding nerves more reactive. This can cause pain to spread, intensify, or persist even when the original mechanical strain seems minor.
In patients with hypermobility or connective tissue laxity, inflammation can be especially disruptive. A small mechanical strain may create a larger-than-expected immune response. When the immune system overreacts to irritation, the body can turn a minor strain into a severe flare.
Inflammation can also affect collagen and connective tissue. In some autoimmune conditions, the immune system may contribute to tissue breakdown, joint laxity, tendon irritation, ligament pain, or progressive instability. For this reason, the inflammatory system must be understood before structural repair is considered.
Some patients have inflammatory symptoms even when standard autoimmune blood tests appear normal. These are often called seronegative conditions. In these cases, the diagnosis may depend on the clinical pattern, physical examination, medication response, ultrasound, MRI, or signs of inflammation in tendons, ligaments, joints, or soft tissues.
Mechanical pain often worsens with use. Inflammatory pain often behaves differently. Patients may wake with deep stiffness, pain, swelling, or heaviness that improves slowly with movement and worsens again after prolonged inactivity. Fatigue, brain fog, and whole-body flares may also point toward an inflammatory driver.
Enthesitis is inflammation where tendons or ligaments attach to bone. It can be severe and focal, especially in conditions such as psoriatic arthritis or other spondyloarthropathies. Enthesitis may appear around the sacroiliac region, pelvis, ribs, Achilles tendon, shoulder, jaw, or other attachment points.
Inflammation does not only affect joints. It can sensitize the nervous system and make the body more reactive to normal stimuli. Patients may experience widespread pain, burning, tingling, fatigue, temperature sensitivity, autonomic symptoms, or pain that seems disproportionate to visible findings.
Discovery begins with the pattern. We look at where symptoms occur, when they are worst, what triggers flares, what improves them, and whether the pain behaves mechanically, inflammatory, neurologically, or as a combination.
Evaluation may include a detailed history, physical examination, review of prior labs, targeted laboratory testing, musculoskeletal ultrasound, MRI review, medication response, and assessment for related conditions such as hypermobility, mast cell activation, small fiber neuropathy, dysautonomia, post-infectious syndromes, or chronic pain sensitization.
When standard labs are normal but the clinical picture suggests inflammation, the team may look for other forms of evidence. A short anti-inflammatory or steroid trial may help clarify whether inflammation is a meaningful driver. Advanced imaging may reveal synovitis, tenosynovitis, ligament thickening, tendon inflammation, or early erosive changes that standard X-rays can miss.
Treatment starts by controlling the fire. If autoimmune or inflammatory activity is active, it often needs to be addressed before procedures, rehabilitation progression, or regenerative treatments can succeed.
Regenerative medicine depends on a controlled healing response. Treatments such as prolotherapy and platelet-rich plasma are designed to stimulate tissue repair. If the immune system is actively dysregulated, that controlled response may become excessive and painful.
For this reason, MPM works to identify and calm autoimmune or inflammatory activity before pursuing structural repair when inflammation appears to be active. The goal is not to avoid regenerative or procedural care, but to choose the right timing and sequence.
Maintenance begins when inflammation is better understood, major flare drivers are controlled, and the patient has a clearer plan for recognizing and responding to symptoms. Some patients may require ongoing medication management. Others may need periodic monitoring, rehabilitation, flare plans, or coordination across specialties.
Long-term care focuses on helping patients distinguish between inflammatory flares, mechanical strain, nerve sensitization, and new clinical changes. This body literacy helps reduce fear, prevent unnecessary escalation, and support more confident self-management.
