52 yr male, joint pain for 3 mo, getting worse. no fever. alt-309 and ast 162. slight anemia. all tests for inflammation have been negative. naltrexone was only new medicine. suggestions for next tests and specialist?

You need a team care which includes hepatologist and rheumatologist besides you family doctor. Chronic active hepatitis C comes first in my mind when I see your medical history and current medication but there are other conditions which can cause liver and joint diseases. I wonder what the negative inflammation tests are.

In addition to viral hepatitis, autoimmune disorder and fatty liver are other possibilities. I would start with consulting a hepatologist or gastroenterologist to start the investigation.