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Arthritis Action
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Can you have RA without swelling?

I had blood tests recently which have come back abnormal - my rheumatoid factor has been increasing out of normal range to higher levels and I have iron deficiency anaemia, along with out of normal range ESR (low) and low lymphocyte count. Some of my other blood tests are out of range.

I have been feeling very lethargic and tired, with pains in the top joints of two of my fingers and thumb of my right hand, occasionally accompanied with bruising. The Doctor mentioned RA, but doesn't believe I have it as I have no visible problems with my hands such as swelling. My Doctor didn't seem overly concerned saying my blood test results weren't that out of range, but why bother calling me in to say that? I have other aches and pains too.

My Doctor prescribed iron tablets, but is not looking into the cause of my abnormal blood tests. She said if I did have arthritis, it is more likely to be osteoarthritis (because of the joints affected).

She asked if I have psoriasis. I replied that one of her colleagues believed I had psoriasis and possibly psoratic arthritis (my cousin has it), but then I saw a locum 2 weeks ago who said I don't have either; I have dermatitis instead.

Can you have RA without swelling? If not RA, any thoughts as to what it could be?

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Your GP is probably right about joints affected meaning you have early osteoarthritis rather than RA. RA only affects the synovial joints i.e. knuckles and joints in middle of fingers and toes. I've never heard of ESR being too low - it's usually elevated i.e over 0-10 - but aenaemia is common with all types of inflammatory arthritis and other inflammatory diseases - also can be just something some suffer despite no underlying disease. However if you feel your pain exceeds wear and tear and your raised RF and low lymphocyte continue to be of concern - you could ask for more specific tests for Lupus and Sjögren's . I have Sjögren's that was previously misdiagnosed as RA and both of these diseases can cause early osteoarthritis or inflammatory arthritis.

Regarding PsA - this usually shows up over time as sausage fingers and red, swollen joints and often affects the back and hips and other large joints too I believe. My cousin has it too but without the psoriasis - although there's plenty psoriasis in her family. It's hard to diagnose as no specific markers. You could request an ultrasound to check for signs of inflammation as this is the most accurate method of testing.

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Thank you for kindly replying to my post. Sorry, I meant to say my ESR was higher than normal range!

It is interesting what you say about Sjogrens as my Mum has this.

My doctor told me that the rheumatoid factor blood test isn't diagnostic.

I definitely feel something is amiss with my health, but it sounds from what my doctor says that I will have to sit it out and see how things develop (or not).

Thank you for your very informative advice.

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There are more diagnostic tests for all the rheumatic diseases but only a rheumatologist can order them. The Rheumatoid factor abs ANA can be lowish positive in healthy people but both are often clear/ high positive for people with Sjögren's and RA. All these things form a picture but they can all be negative for some sufferers. The fact that you have symptoms, +RF and elevated ESR should prompt a referral to a rheumatologist - there are more diseases than RA and if your mum has Sjögren's this should act as an extra prompt for referal. I'd push your GP hard to get on with it if I were you. They aren't specialists!

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Hi. I didn't have redness or swelling for a few years but it has started now. My consultant said that ra isn't always visible. I hope you get to the bottom of it.

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Hi TitanRed321! I had a crazy quilt of changing and elusive test results, but the last one showed a very positive anti-CCP reading--but no swelling. The rheumy diagnosed me with RA, and wouldn't you know it, within 6 weeks time, I got swelling in my metacarpal joints. Bingo. So, yes, it can happen!

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I have lots of joints affected like fingers and hips my doctor diagnosed me because my hip had been sore but not swollen I went for a scan and descovered my hip had gunk in it

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