Anyone else not flare?

I had arthritis in all my joints really bad.But no obviously swelling. However I do have some finger deformity and am definitely damaged. people talk of DAS and things like that but I wonder would I even qualify for biologics etc if I had no obvious swelling. I seem to get offered nothing due to looking mostly ok. My pain is constant and always bad. I also have a normal esr etc .


Kat x

12 Replies

Hi Kat, I'm sorry your not having a good time right now.

You say you have arthritis, do you know what sort of arthritis? Is it osteo or have you been diagnoses with rheumatoid or psoriatic arthritis? Depending on what sort of arthritis you have will depend upon the treatment you're offered.

It's quite possible to have RA and to have normal bloods and not everyone has massive swelling either. If you have been diagnosed with RA or another inflammatory arthritis then the first line of treatment is usually dmards like methotrexate, sulfasalasine and lots of others to try. It's only after trying these for set periods of time and not getting your disease under control that they may look at biologics. As you mentioned, there is strict criteria to qualify for biologics and one of these is having a sufficiently high das score. I am led to believe that it can be hard to get the required das score unless your bloods are also elevated, but I'm not sure about that.

If you have osteo then I don't think any of the above are suitable, but as I don't have osteo I'm not an expert on this. I'm sure you'll find lots of useful information on arthritis uk.

Its definitely worth going back to your GP and asking for some help and explaining what you've said on here. When is your next appointment with your rheumatologist?

I hope you soon feel better,



Hi Rosie. Thankyou very much I have psoriasis arthritis. It is March the 18th. Maybe I will have to ask my rheumatologist/gp as you said.Thanks :)


My ESR blood tests never were that high but I had lots of joints affected either tender and or swollen. I had problems with hands elbows shoulders hips knees and feet. I was approved for biologic therapy after two assessments. I had been on various DMARDs for about 7 years building up to a triple therapy. You need to have tried other drugs without good results before being considered for biologic therapy. Usually these have to have included methotrexate. You won't normally be DAS scored until you have been on treatment for some time.

Low ESR doesn't mean you can't get biologics.

Hope this helps



Hi Cecil, that's really good to hear. I had thought from comments on hear from others that this might not be possible but it's great to hear that isn't the case. I know that the criteria seems to be set quite high to get them. I hope you're doing well on them, Rx


Thank you cecil! x


My rheumy says in Scandinavia DAS of 3.0 gets you biologics in the UK it is 5.2!!


I have PsA too. My personal experience suggests that some rheumys don't know enough about PsA to treat it as aggressively as might be required. As I understand it, PsA doesn't necessarily show raised ESR, nor swelling come to that, but it can trundle on anyway and requires treatment. The DAS score does not apply to PsA, it's a way of assessing RA.

You may not need biologics, other drugs such as DMARDs may help, but it sounds as if your rheumy needs to take your particular issues on board and address your pain and possible risk of further damage.


Hi Postle. My Dr has been hesitant since my diagnosis to confirm PsA or RA because of the particular finger joints that are affected and my blood tests. In the end she diagnosed RA, she told me this was because there is a wider range of treatments available or at least licensed/used to treat RA. However I have just found out my DAS score isn't high enough for RA biologics despite meeting the criteria confirming I have failed to respond to the DMARDS. Do you know if PsA is also treated with biologics if DMARDS fail and where I could look for information on the assessment criteria if the DAS score does not apply? I'd appreciate any information you could give me. Thanks


I guess the best thing is to have a discussion with your rheumy about all this - sounds like a few things need clarifying.

But yes, PsA is also treated with Biologics and this site outlines the criteria (it's NICE guidance from 2010 but I don't think it's changed since then):


Thank you. I will discuss it with them I was just hoping to go armed with information. My consultant can't see me until July and I've never met the doctor I've been booked to see in the meantime so I don't know how much background information she'll have or whether she'll be aware there has been such debate about my diagnosis so its useful for me to go with as much information and questions as possible so I appreciate your help.


I was told didn't have RA as ESR not too bad although had pos Rheum factor. Then they did anti CCP and next time I went back confirmed diagnosis. Bit of a relief really as can be treated. Been having swelling and pain in various joints lasting from 24. -48 hours since Nov 1013. All my joints seem to take turns would like to take time off till MTX and hydroxy kick in but 1/2 time I'm ok and feel like a fraud.


I have psa and so don't have a das score . I too feel psa id not as understood. I now tell people I have ra (not medical people) just cos they mighy have heard of it ..


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