RA without swelling?


I've just been to an appointment with a registrar today and was told that from the tests and symptoms so far they can't really say yet what I have. I definitely have osteoarthritis but other pains/stiffness symptoms are not conclusive. If I understood him correctly they seem to be most puzzled by the fact that I hardly ever have any swelling or at least significant swelling with the pain/stiffness and no signs in blood etc of inflammation. The latter could perhaps be to do with me taking ibuprofen everyday. So now I am wondering if anyone else With diagnosed RA has little swelling of joints?

17 Replies

  • When I first got RA I just had on one hand red knuckles and one joint seemed to have grown but not swollen! Then it started with the other hand too so that is when I first went to GP and was sent to rheumatology at hospital within 2 weeks and diagnosed then but I did have raised anti ccp and RA factor but have read many times you can be sero negative (ie no ra factor) .

  • Hello

    Depending on your condition the inflammation could be in remission.


  • Hi - sorry you are having a hard time getting clarity about what is wrong.

    Much of my pain and swelling isn't visible to the naked eye and comes in the form of neuropathic pain. For example I am having a flare just now but have no visible swellings nor is any one joint extra painful or stiff. I just have toothache- like pàin in every tendon and joint in my body including my jaw and larynx.

    When I was diagnosed I did have very swollen knuckles and fingers but my wrists were excruciating and yet there was barely any sign of swelling at all. My ESR (sed rate) usually accurately reflects the way I feel and is currently 58 (normal 0-10) - not the highest I've ever had but proof that it's not in my head - just in case my head tries to tell me it is!

    There are the conditions Fibromyalgia and CFS which don't show up in the blood or cause visible swelling at all - although you can also have both with RA. I don't suffer from these myself but it may be worth looking them up in case you are told you do.

    I am not sure about this but I think I read that seronegative RA is more likely to cause pain without swelling. It can be a hard disease for rheumatologists to rule out sometimes because occasionally it doesn't show up either as swelling or in the blood.

    However there are over 200 types of inflammatory arthritis - some of which are Seronegative so even if it's not RA it is obviously something. Keep pushing because some of the less common types of inflammatory arthritis diseases can be overlooked such as Lupus, Ankylosing Spondolitis (sp?) and certain types of Vasculitis. Hang in there you certainly aren't alone.

    And yes ibuprofen will influence your inflammation markers a bit so best avoid for a few days or even a week prior to getting bloods done or seeing a rheumy.

  • Hi,

    I have never had a great deal of swelling and sometimes I can feel it without it being enough to be visible. I also have osteo and I just get treated for both.


  • I too don't get a lot of swelling,but i get all the pain sadly. My shows don't show any activity either so i don't know, I get tired of telling them i am in pain.xxxxx

  • Thanks so much for your replies! It makes me feel better to read that I'm not some impostor imagining the pain and that there can be other forms of arthritis to consider. I will look into what you have mentioned! Thank you all and have a good day with hopefully no or little pain!!

  • I have sero-negative RA and I have never had significant swelling. It's important to note that even without the redness and swelling, if there is joint pain there can still be joint damage. I started having joint pain in my teens and now in my fifties I've had 5 hand/wrist surgeries with several more pending. Doctors were initially confused by my condition as they seem to be by yours. I wasn't given the diagnosis of RA until my mid-thirties and never had anything significant show up in my blood work until my forties. This autoimmune stuff can be confusing. I wish you well.

  • Hi, I'm going through the same as you at the moment. I've had Pain and stiffness everyday in hands elbows and feet joints for a year but no swelling nothing in blood test or X-ray but the rheumatoligist said to try treatment with Hydroxychloroquine to start on my next appointment.

  • So sorry you are suffering too without any firm diagnosis. I'm in a similar situation. Started with pain and swelling in fingers had all the tests, bloods show nothing, but ultra sound scan shows inflamation in fingers, also Osteo arthritis. My hands are still swollen and painful, the palms are very red and hot, originally thought I had sero negative inflammatory arthritis, but because I didn't respond to or tolerate Methotrexate or Sulpasalazine and now Hydroxychloroquine, they are not sure what I have. Could be "diabetic neuropathy" , or "Fibromyalgia" I am Diabetic and also have Fibromyalgia, but my GP doesn't agree with these diagnoses. I have my appointment on Thursday with RHEUMY so I'm hoping for some answers as at the moment my gp won't do any further investigations unless called for by the Rheumatologist. Still on hydroxychloroquine, but no difference, now getting hard nodules on the sides of my fingers, not sure what these are. Can't tolerate strong pain meds so not sure what will happen. Will let you know the outcome.

    I do hope you find some solution to your problem.


  • I also have no swelling ( at the mo). My inflammatory arthritis also started with swollen knuckles then moved to the other hand. Also tendons seemed inflamed in hands off and on. Then right knee then left -this carried on until about last September. Then the swelling stopped and since then continually painful fingers / wrists but hands look normal. Although my palms below little finger are blotchy/red. My rheumy has never said yes you have RA, blood tests are all negative and normal, but have now started with MTX. So just waiting to see. I did have cystitis twice before most of the swelling started so Reactive Arthritis was mentioned. Hope you get it sorted.

  • I'm sero-positive, with no swelling to speak of for my first 24 years with this disease. This led to incorrect initial diagnosis (of SLE) and undertreatment for a very long time. I was only finally properly diagnosed when an MRI of my sore neck revealed rheumatiod pannus & erosion of the top 2 cervical vertebrae. You should have seen the look on the rheumatologist's face that day! I have only developed swelling in my finger & toe joints in the last few months. As far as blood markers go, the doctors just shift the goal posts all the time - if your ESR is low, that's a good thing & if your ESR is high then they suddenly don't put much value on ESR.

    Based on my experience, I'd suggest you keep on about the effect pain, stiffness, fatigue etc, etc are having on your life and insist that they don't make decisions about treatment solely based on that stupid DAS chart. (DAS scoring hinges on the supposition that the hands are a true & complete reflection of what is going on in the rest of the body.....rather a brave supposition for a disease that is so variable.....and certainly not true for everyone.)

  • I owe you a big thank you Livingston but I am now more mad with my rheumy. I have RA but have recently been diagnosed with osteoarthritis in the end of my finger joints think they are called hebridian nodules. This was at last appointment. So I told him about a finger I am having trouble with it is triggering and he straightaway said Osteo. I said how can it be osteo when I had triggering in another finger (same joint pip) that you never called osteo and treated with a steroid injection. So I then said ok where I have pain in my neck and have had 2 flares in it What is that and he said osteo,the first one being waking up and not being able to move and after 2 hours of trying to move I cannot hold my head up and my arm is stuck by my side so at that moment I felt that I had had a stroke and the second after having a day of violent headache and waking up not being able to move neck from left to right. At that moment I felt so let down in someone that I had always trusted. They were both classic flares I have osteo in my shoulder so I know about the pain of that and this is completely different. Even my Occupational therapist when I told her that my rheumatologist had said I had osteo in my dip joints because RA does not affect those joints shook her head and I looked at her puzzingly and she said that comes from the text book and it does affect dip joints. I should have known really as after a flare in one hand a tiny node appeared in my dip joint of my little finger and that finger splays outwards. Sorry I am ranting and I am sorry you have it in yur neck but rather pleased that I have learned that you can get RA in your neck.

  • Hi

    RA can affect any part of the body where there is synovial tissue - so any joint at all. The story about only osteo affecting the DIP joints is so much c*** and a rather old fashioned view, but unfortunately still out there.

    Not to worry about having a wee rant - sometimes there's just nothing else for it :)

  • I also have the same issues currently with my Rheumatoid Arthritis. I was diagnosed with it a few years ago while I was pregnant with my second son. I recently had a bone scan done of my entire body that showed no inflammation. I was shocked and worried it showed nothing as I was in so much pain my husband had to drive me to that appointment! what is it then if there is no inflammation?! i see my doctor again June 2nd and want to know what is going on with my body! I am so tired of being in so much pain. And now being treated like and somewhat feeling like it is just in my head now is sad. Thanks for reading :)

  • I've got the opposite, sort of. In that I have no swelling or inflammation at all. My inflammatory markers are 0.4 crp and 6 esr and have been for at least the past 7 months since my hands and feet started to ache. But I have pain in my hands and feet. The rheumy says it must be RA and notwithstanding what the inflammatory marker blood tests show, there must be inflammation in my hands and feet if I am feeling pain. He believes that pain in the hand and feet can only be caused by inflammation irrespective what the bloods show. I am sero positive. And confused. The MTX had no effect on me after 16 weeks at 15mg.

  • I'm going through the same exact problem right now. Inconsistently stiff fingers/hands/wrists/knees, with inconsistent bouts of pain and tenderness. Red joints and the whole 9. Blood tests show nothing at all , though, and she's not willing to just throw a shot in the dark for the sake of a diagnosis. It's extremely, extremely frustrating. I hope you get answers soon!

  • Thank you James and I wish you the same!

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