I had asked for some further information and have not heard back.
The recommendation for next steps would typically be dependent upon the findings on the previous evaluation.
If the x-rays and CT scan showed primarily degenerative changes or wear and tear, then a trial of another anti-inflammatory medicine would be appropriate. If there are anatomic defects that predispose to the development of degenerative changes, then a specific intervention for that anatomic defect would be appropriate.
It also would be appropriate to consider evaluation for systemic inflammatory conditions, such as rheumatoid arthritis or systemic lupus. The x-rays and CT scan may have some findings to suggest certain inflammatory conditions, but there also are certain blood tests that can be done, including a sed rate, rheumatoid factor, and anti-nuclear antibody (ANA).
In addition, it would be appropriate to continue vitamin D supplementation until the blood level is normal. If the evaluation does not find any specific underlying cause, then it also may help to use a medicine that can help chronic musculoskeletal pain from a variety of causes, including certain anticonvulsants, such as gabapentin or pregabalin, or certain antidepressants, such as amitriptyline or duloxetine. In someone that also has significant depression or anxiety, then the use of an antidepressant would usually be preferred.
If I can provide any clarification, please let me know.