Joint pain without swelling

[Gem_stone]

Hi .. I'm new here.. And i have a question..does anyone here experiencing joint pain without swelling or redness? And have been through laboratory tests like ANA, rheumatoid arthritis and ESR with negative results? 

[nomoreheels]

Hiya Gem_stone, welcome. I have both RD (or rheumatoid arthritis) & OA (osteoarthritis) & on occasion have what I call bone pain without inflammation. Generally if I have inflammation I have disease activity going on or I'm experiencing a flare but otherwise quite well controlled with the help of meds. My inflammatory markers don't always match what I'm actually experiencing, it can be so. 

OA is more typically non inflammatory (which seems to contradict) but it's not a boggy type of inflammation as experienced with RD, when you press it it's a harder type of inflammation if that makes sense? If you've been taking an anti inflammatory for some time prior to being tested (even over the counter ones) this could give an inaccurate ESR (or CRP) result. Normal levels don't rule out RD, though if that is the case it may be less likely that damage develops in joints than those with high levels of inflammation, especially an elevated CRP. As you've been tested for Rheumatoid Factor, ANA & inflammation did you not also have an anti-CCP antibody test? This is a more sensitive test than RF but still if taken early on in the disease can come back as a low count in someone with early RD. 

I don't want to presume your age but has osteoarthritis been discussed or any imaging done to determine just what it is causing your joint pain? Was it your GP who took the blood tests? Sorry for the questions but it may help. It may also help to have a read through this to distinguish your symptoms nras.org.uk/making-a-diagno...

I hope this has helped, if not or if there's anything else you think of that's relevant & need answering just ask away & we'll try to help if we can.

[pinksugarmouse in reply to nomoreheels]

Out of interest nomoreheels do you think rheumatoid arthritis should be called rheumatoid disease? Do you think calling it arthritis reflects all the health problems and difficulties the condition causes?

[nomoreheels in reply to pinksugarmouse]

Yes Pinky, I've been doing so for I suppose a couple of years now & actually so does my Rheumy & her team, when discussing it anyway, she considers it more appropriate. I guess it's not well enough out there to include in reports though, yet. It's definitely better understood now when I'm asked what I have, it seems to make people think rather than as before with the arthritis tag "I have that & just take ibuprofen" et al, they understand osteoarthritis but I also have RD. If whoever asks wants more info then I'll explain the difference depending on how much is needed.... question & answer rather than chapter & verse if you get my meaning! 

[iAce in reply to pinksugarmouse]

Pinksugarmouse I certainly think it should be called RD if not just so that people will stop telling me to "just take some painkillers as my nan had that, or your too young to have worn your joints out yet"

Even my own family had to be sat down and told the differences a few times before the severity of the condition and my symptoms finally sank in.

RD is so all encompassing at times the term RA seems to only conjure up bone/joint problems when it can be far more systemic than that

[Gem_stone in reply to nomoreheels]

i haven't been through an anti-CCP antibody test and i don't have any idea about that thing because i'm only 16 y/o. Thank you for answering my question nomoreheels. one more thing though, i was around 8 or 9 since i started to feel this pain on my knees and it really hurts like hell. actually i dont know if the pain is from the joint or muscle, nerves, whatsoever. my mother said maybe this is juvenile rheumatic arthritis, the same with my older sister.  the only difference is i didn't experienced inflammation. and now, im suffering lower back pain too. i don't know if this is even related or this is another illness because i accidentally lost my balance,and  got slipped on the floor.

[nomoreheels in reply to Gem_stone]

If you don't mind can I ask a few more questions Gem_stone? Have you had the blood tests (ANA, RF & ESR) & the results were negative, is that what you meant in your original question? If so what did your GP say may (or may not) be the cause of your pain when he gave you the results of the tests? It's just that as I mentioned the anti CCP test is more sensitive & one which GP's can do but don't always perform due to cost so if he's not certain it may be worth seeing him again as you're still in pain, something's causing it & it's better to keep on trying to find out.

Is the GP you saw aware that your sister has JRA? That may be relative even if the tests you've had were negative, these tests aren't infallible, particularly when taken at very early onset. Neither is it out of the question someone as young as you can have osteoarthritis (OA), though it is more unusual given that it's a degenerative condition.

Another thing, particularly with you saying about back pain, have you researched spondyloarthritis? I believe (though not sure as I don't have one) that whilst some of the tests you may have had can come back positive in around 50% of those tested they may not so of course could be negative. I think I'm right in saying the same applies for Palindromic Arthritis too, particularly if you were tested when you were relatively symptom free or even if you'd taken an anti inflammatory like ibuprofen or pain relief for the pain some time just before being tested, even though you have no inflammation.

Just a few things to think about, maybe talk them through with your mother. Autoimmune diseases of all kinds can run in families, just as your sister has JRA it should give your GP warning signs that it could be that you have something autoimmune going on too.

Again, I hope some of this helps & as you continue to be in pain do see your doctor again, something isn't right.

[Snooze-Master in reply to nomoreheels]

Ive been trying to describe my RA swellings, boggy, thank you, perfect word.

[nomoreheels in reply to Snooze-Master]

Glad to be of help!

[pinksugarmouse]

Some people tend to assume that those of us whose RA doesn't show in our blood tests have a 'watered down' version of RA. This is absolutely NOT true. In fact because blood tests show up normal it can take longer for a diagnosis and therefore put us at far greater risk of joint damage before the right diagnosis and the right treatment is given. I have sereo negative RA and have had terrible flare-ups causing joint damage. It's still good to have regular blood tests though because it can detect other possible health problems such as anaemia. Nomoreheels is right though, some blood tests are more detailed than others.

It also means that you absolutely HAVE to learn to understand how your RA effects you personally. What is normal for you and what isn't, because only you can tell if there are changes. X-rays will too, but at that stage the damage is done.

Pains can vary from joint to joint. For example I get bruising, gnawing and cracking pains from my knees, shooting pains in my fingers, gnawing in my wrists, aching and cracking in my jaw and aching in my feet. I get shooting pains and aching in my back and spine.

Some joints are more likely to show inflammation than others. Knees for example often give out big warning signs but the fingers, wrists, hips and spine might not. It's worth keeping a record of the different pains in your joints, when you feel them, for how long etc. You and those treating you will depend on this information to monitor your condition. Remember RA can effect other parts of your body too. Make sure you have regular eye tests and tell the optician you have RA.

Again I agree with nomoreheels RA can cause an overall 'boggy feeling' whether your joints are swelling or not. If you are having a flare up you might feel a lot more tired than usual and your muscles can feel heavy as well. It's like walking through treacle. It's a bit hard to explain but this is why many people with RA think it should be called Rheumatoid Disease to reflect that it's not all about swollen joints.

And on that cheery note good luck xx

[nomoreheels in reply to pinksugarmouse]

.... not only that it's not all about swollen joints but to distinguish it from OA, the more common form of joint disease most think we have, sometimes called wear & tear arthritis & usually degenerative, though not always it's worth saying. Neverthless not autoimmune & without the comorbitidies which often are secondary with RD.

[flow4]

Hi Gem, yes it's possible, and it was the case with me (though not as much as I thought, but I'll come on to that...) It is quite common with spondyloarthris and psoriatic arthritis, which tend to affect the entheses (the points where tendons attach to bones) more than the joint capsule. The way it has been explained to me is that joint capsules are like little caves mostly surrounded by bone, so when you get inflammation in them, it bulges out between the bones where it can, and is quite noticeable. But when the inflammation affects your entheses, these are not enclosed, so the swelling can spread in all directions, and is less noticeable.

I didn't think I had *any* visible swelling at first, but it hurt and was hot just like I imagined it would if I did have swelling, so I started to watch more carefully. I noticed slight swelling, hardly visible, but definitely 'squishable' when I squeezed. I then started taking photos, when it hurt and didn't hurt (I.e. after steroid treatment) and discovered that the swelling *was* visible after all - just less dramatically than people generally expect.

There are other more likely/common reasons for joint pain though, including osteoarthritis (as nomoreheels says), and fibromyalgia, hypermobility syndrome, vitamin D deficiency...

[earthwitch]

I have spondyloarthritis (ankylosing spondylitis) and it is only very rarely that my actively inflamed joints show any swelling or redness - that seems to be because of where and what type of tissue is actually involved.  In spondy it is largely the entheses, and this type of tissue is more like cartilage so doesn't really swell when inflammed.  it sure can hurt though.

[sunshineju]

Hi there, 

I had severe pain in feet and hands Fir at least a year before being referred to rheumatologist.  When I saw her the first time she examined feet hands and most joints and said that there was slight puffiness but not swellings so to be sure she organised an ultrasound which confirmed synovitis and erosion in the same joints on each foot and hand. Then had mri shortly after which showed the true degree of erosion and active synovitis.  I wasn't surprised as I had so much pain. But relieved rheumatologist asked for the ultrasound otherwise my symptoms would have been misdiagnosed as fibromyalgia.  My bloods were normal, and still are sort of two years later apart from crp levels and liver function, so I'm seronegative. The thing to remember is not everyone has hot swollen joints as a tell tail sign of ra. When I sore my rheumatoligy nurse she instantly pointed out on my hands where there was swelling,I hadn't noticed it as swelling, she explained everyone reacts differenly and that she could spot inflammation after so many years of working with ra. No two people are the same. Unless there is an ultrasound or mri to confirm then alot of people can go undiagnosed. Blood tests can change over the course of the ra, but I remember being told my bloods were fine my joints weren't swollen it's just fibromyalgia!  Fortunately I saw a different gp who agreed all my symptoms were in need of a consultation with a rheumatologist thank goodness I did. Good luck. 

[turtlemom2]

Yes. I have joint pain but I do not always swell and I never have gotten the redness some get with RA. Not everyone will get the whole list of markers. Each person is different. I get really tender to the touch when I am getting a flare up. Not red but tender and only sometimes do I swell. I get it really bad if I am stressed or if the weather changes.