Is it possible to have RA and have normal bloods including CRP?
Normal bloods : Is it possible to have RA and have... - NRAS
Normal bloods
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Frech
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Hi Frech, Yes...I think so...RA is a mysterious condition at times!! My CRP is always low even when in during asevere flare at about 14, my PV is usually high though. My RF was slightly above average but the anti-ccp test was through the roof showing very active RA but that wasn’t done until two years into diagnosis. I’m sure someone will be along soon to give you a more detailed response but my reply is on my experience...is it the same for you? Good luck and hope you’re ok. 😊
Thankyou
I’ve had what has been treated as plantar fasciitis for last 18 months but I have not been responding to any treatments. My feet are excruciating painful especially in a morning or after rest which is typical of fasciitis but also I believe of RA. ? Over last few months things have got worse! I can now barely walk for pain in feet ankles and toes. I also have very painful elbows and hands. I couldnt sleep last night for a burning sensation in my big toe. My physio and podiatrist started to wonder if something else was going on and did bloods and referred to rheumatology. My bloods have all come back normal so I’m not classed as urgent for an appointment and have been given one in November. In meantime I’m in agony and feel my life is on hold. Obviously i don’t want RA i just want to know what it is so I can get some relief. I’m worried if it is just plantar fasciitis and the other pain is due to my gait and walking etc because of the foot problem that I’m delaying getting further help with that. I keep telling myself it can’t be RA because of the normal bloods especially the CRP but I really don’t know. You start to think your going mad or even imagining it and causing a fuss about nothing. Feel so petty one minute a pain here then a pain there it sounds so pathetic. I slept last night with one foot out of covers because I felt like my toe was on fire. ( what’s all that about ) I just feel tired and unwell all the time and feel like I’m getting no where fast. Don’t know whether to laugh or cry 😥🤣🤣. I stick to laughing because I’m that sort of person 😃😃 but it’s starting to get me down at the moment I have no life and if it turns out to just be the plantar fasciitis I’m gonna look really daft.
Xx
Have you had any imaging done? That might help uncover what's up. As could be loads of things (gout, tarsal tunnel, osteoarthritis,for example) so maybe GP could do a bit more investigation while waiting for rheumy appointment.
I have ultrasound scan on my feet on the 24th so I’m hoping that might give more information
That should be helpful. And a lot nearer than November!
Yes fingers crossed . I just want to get to the bottom of it.
I’ve always been healthy and I hate how this is limiting me. I have a dog that I need to be walking and it’s frustrating I cant 😕
Just an idea about your dog. I use a mobility scooter to exercise my dog. I bought a road going one as they're faster. My dog runs alongside my scooter (on an extended lead). He loves it!!
Bless you...it’s awful being in so much pain and thinking you’re going mad, have been there and you’re not going mad!! I was back and forth to the doctor for two years..with extremely painful hands and being fobbed off...until “luckily!!” My right hand swelled with classic RA symptoms got finally to see a Rheumatologist and was diagnosed within 10 minutes. It does get you down but persevere as much as you can and be persistent....you do learn to fight your corner so to speak and to be a “polite” nuisance 😂. I really hope you don’t have RA though and get some answers soon. Look after yourself xx
Well I have exactly the same symptoms as u. Nothing showing in my blood but been diagnosed with psoriasis arthritis and starting methotrexate next week. I've had these painful feet/ankles for almost 2 years and have tried everything from exercise to ultrasound guided cortisone injections. Nothing much but mild bursitis seen on scans. It's been so frustrating and like u my life has been on hold. Steroid injections into the muscle (bottom) gives good relief for about a month but slowly the inflammation starts creeping back. So as a last resort I'm trying methotrexate and hoping it works as the constant pain is debilitating. Good luck with yours. November is a long time to wait when in pain.
Yes it’s so frustrating. I’m training to be a counsellor and I’m about to pay next years course fees which is a lot of money. Also I’m about to start a placement in the nhs. At the moment I’m just not sure I can do it. At same time I dont want to throw away all I’ve worked hard for. Do u have the skin condition as well ? I did wonder about psoriatic arthritis but I have a history of excema but not psoriasis. I hope the treatment works for you x
I was told that you do not need to have psoriasis but a first degree relative with it. Plantars fasciitis is a common symptom.
I had all what your saying, and the being treated for the same thing in my feet. It was my Endocrine consultant who first thought RA as my middle finger on my right hand wouldn’t straighten, she said a typical sign of RA, and referred
Me over to the rhumy team in the hospital, by pasted the GP, got appointment two days later. Had every test under the sun, a lot came back as not showing, but one showed signs of it possibly starting, as I’ve got it caught so early maybe that’s why the treatment is working so well. But as I said before CRP neg
Diagnosis tends to be made when you have several of these signs/symptoms: swollen & tender joints, positive antibody tests (RF &/or anti-CCP), morning stiffness, raised inflammation markers, and duration of symptoms for at least 6 weeks.
If you only have one or sometimes two of these then it's less likely that you be classed as having RA.
I have all the symptoms minus the inflammation in the blood. RA doesn't always show in the blood and many are diagnosed by their symptoms alone.
Yes, good example of what I mean. It would be so much easier if there was a single test that was 100% reliable but there isn't, so we are left with this mix & match approach to diagnosis.
My bloods never show any problems,yet i still have pain and swelling.xxx
Hello.
Yes, mine were abnormal for 15years plus and now are normal. I thought oh good I won’t have to take the medicine, but the rh factor says no, it’s still active and it’s just that the drugs are suiting me finally. I do know I feel a lot better when my bloods are good. I don’t have as many awful pain days, just when the weather swings or I overdo things. So I hope my comment helps, it seems such a perplexing disease. I love this site.
To add the rheumatoid factor will tell, anaemia, esr and crp initially. But the picture of your joints and symptoms of when and where and duration is more important. How it all started etc.
Apart from the blood tests I had at the start of the diagnosis process and starting Hydroxychloroquine, my bloods are all normal.
Curious about the plantar facititis, I had that for about a year a few years before the acute shoulder pain which led to me seeing the GP. I had never connected the 2 and perhaps I should have.
The same as mine. Started in my feet then woke up one day with horrendous shoulder pain which forced me to seek help.
Apart from a persistant low white blood count (which so far has improved on DMARDs - strange ) my bloods have been normal with no inflammitory markers - ever. Yet I have extreme brain fog, hot , stiff painful joints , some slightly swollen, ulnar deviation and deformed hands and dry gritty eyes.
After much delay , I was eventually diagnosed as sero negative RA.
Some say sero negative is less aggressive than sero positive, but this has not been my experience. My hands in particular have deteriorated rapidly. So do ask for more help/ investigations.
It was by persistence and a letter from physio that eventually got my GP moving.
Most cases of RA show normal blood results for the first 12 months, even when there is a sudden onset.
Blood levels can be influenced by other factors such as exercise and diet - no exercise, obesity, smoking excess alcohol and a poor inflammatory diet will show high levels of inflammation in the absence of RA.
I had normal blood results and my first NHS appt was not for six months and the GP would not even do an x-ray. Various imaging (ultrasound, MRI) showed numerous RA signs, whilst x-ray ruled out the osteoarthritis presumed because of age. I stopped exercising when I went on a cruise and had a lot of alcohol and the blood results taken just afterwards were abnormal. I started exercising again and they fell back to normal but RA was confirmed by imaging.
What did they see with imaging? Joint damage?
Quite an assortment of things which made the diagnosis indisputable - synovial thickening, inflammation, effusions, increased vascularity (which is when RA lays down extra blood vessels in the synovium which then penetrate into the bone and destroy it). I can't remember everything without looking it up. Yet the bloods were all normal.
A major problem for the NHS is that there are just too many people for the services available and they have to prioritise the most likely cases. This would be a young girl (as it's usually women) who has abnormally increased blood results together with other symptoms like immobility and joint swelling/stiffnessbut who is slim, active, a non-smoker etc. In those cases, it is unlikely to be anything other than RA.
If a person is older, fat, smokes, then there is the possibility for any symptoms to be caused by less urgent conditions like osteoarthritis or that they are just unfit.
Not sure about the younger persons case being more urgent. On NHS u wait your turn unless it's an emergency.
I think you have slightly misunderstood what I meant. Those who seem to be fast tracked are the ones where RA is really not in dispute, and that tends to be young people who do not have lifestyles and symptoms that could be something other than RA.
You don't actually wait your turn on the NHS for RA, though I think if everybody was taken in rotation then the NHS would not risk irreversible damage in delayed cases. I was 65 and waited six months for an NHS appt. On the NICE criteria, everybody is supposed to be seen within three months but some people are prioritised, which means that others are put back. I suppose they are usually right but not always. There are just too many people which is what I think causes them to prioritise. It is no better elsewhere in the world with public health systems.
My niece was prioritised and she was told that she had such wonderfully flexible hands that it could not possibly be RA and they did not even do any tests. She had an accident when she was 15 (hands went through a glass door) but they had not known about that. Likewise, when I got to the hospital I saw a lot of young girls who were being discharged straight away - it was obvious they did not have RA because they had the flexibility of a ballet dancer in all respects.
Sorry I'm even more confused at what u r trying to say? Don't worry about it. The point I was making was I didn't think u were fast tracked due to your age but rather due to severity of your condition.
Yes, it is severity of condition but a lot of the time RA is not obvious. If it is a young person who is unlikely to have abnormal blood results, then that person is more likely to have RA than an older person who might have normal or abnormal blood results. They will then be prioritised. It is not always accurate though as I have seen a lot who got appts in a week or two but did not have RA.
What you could do is keep ringing the hospital appts line to see if there is a cancellation. That is what I did and I got one two months earlier, as otherwise I would have been waiting 8/9 months.
Yes, my regular bloods are always normal but my Vectra is very high.
So sorry that you’re in such immobilising pain.
Just to add my tuppence worth all your foot pain and negative bloods could also, less commonly, apply to other rheumatic conditions just the same - not just RA or PsA.
RA does usually affect the hands and feet first but not always. And it isn’t the case that seronegative is viewed by doctors as milder anymore. It’s just much more slippery and harder to diagnose or treat is all.
So there are quite a few rheumatic diseases that could as easily start with excruciating foot pain and show negative/normal markers - particularly CRP which is usually normal in both Lupus and Sjögren’s.
Also has gout been excluded as my dad had that in his feet and was in complete agony when it flared up? I think it’s the Uric Acid blood test that is used for gout.
In my case my inflammatory bloods were very raised (and I don’t drink or smoke or eat unhealthily as one person has mentioned and I do exercise!) and my RF slightly elevated initially, PV/ ESR high and CRP raised. But the thing that determined my diagnosis of RA was the pain and swelling in my hands. Sadly feet are often discounted where RA disease activity is concerned so it’s great you’re having a scan.
Always make sure you have a few days off NSAIDs or steroids before your bloods or ultrasound are done as they can badly skew the readings.
Despite elevated RF and inflammatory bloods I had to endure 9 long months of polyarthritis and splints and hobbling before this swelling showed up enough in my hands for diagnosis of RA.
Finally after 5 years and off all drugs having been told it was non erosive RA - my ANA showed high positive and some immunoglobulins too and I had a lip biopsy and was rediagnosed with Sjögren’s. My version is very severe but us in my nerves, kidneys and blood (small vessel Vasculitis)
So whatever Is giving you this disabling foot pain I wouldn’t say it’s normal and I really hope that ultrasound determines something that leads to diagnosis and cure.
Frech• in reply to
Thankyou everyone is being so supportive. I’m just a point now where I’m so desperate I don’t honestly care what the diagnosis is as long as I get some treatment.
I’m hopeful it’s just a foot problem and the other pain is because of that but I don’t know. The ankle swelling and pain could be because of the foot issue, the knee pain cause of the ankle pain. The bad elbow, wrist and hand pain because I’m using the top half of my body to literally pull myself around cause the feet won’t take it? Such as when going upstairs. The shoulder pain cause shoulders are taking the strain coming downstairs. I’ve even thought Is the finger pain strain from using my phone too much. 🤪🤪. My mum has bad RA as did her dad. I am overweight so I know that won’t be helping.
I’m at point where I’m
Literally considering a scooter to be able to get dog out which is a bit extreme if what I have is a bit of plantar fasciitis and a poor tolerance of pain. I’m honestly questioning how much of it is just me being pathetic . my gp is trying to get my rheumatology brought forward I’m just literally willing the phone to ring with an appointment. 🤞🤞
• in reply toFrech
Many of us have been there. I think a lot will depend on your ultrasound so hang in there.
You really aren’t being fanciful- why would you imagine such pain? And yes the pain everywhere could be from pulling yourself around I guess but this sounds unlikely to me.
When my feet have been really bad - as they are just now - I tend to try and find obvious stuff to blame like being overweight, plantar fasciitis, ageing (55), wear and tear and confirmed herniated discs ie Sciatica.
But my neuro physio said “no you don’t get this kind of pain in your feet and ankles from any of this - it’s got to be your rheumatic disease” because i describes to her how it’s worse when I get up in the mornings. I have neuropathy masking some of the pain too.
Now I’ve got to get up let my dogs out as hubby at work and I have to take one stair at a time clutching banister as I go. But at least I know that it’s an untreated (I was taken off my treatment due to side effects) systemic disease that’s to blame. Knowing what’s wrong is actually really important.
So you aren’t imagining anything - it’s just your bloods being cruelly unsupportive as they often are for many.
Cheylann• in reply to
Not sure about ultra sound? Mine showed minimal swelling in the bursar yet I'm in crippling pain so ultrasound doesn't always show what is really going on.
• in reply toCheylann
I’ve only had ultrasound once and it showed nothing. But at that time I was on steroids and had only pain in one thumb (OA). I think they are usually quite revealing for the smaller joints at least.
No test is going to be 100% reliable of course but I’ve read of people here being diagnosed by ultrasound when nothing else has shown up.
I had a neuroma remover thinking it was that putting my gait out and causing all my foot pain. No such luck. Surgical site is now healing and I'm in worse pain so it wasn't the neuroma.
Hi Frech... I was diagnosed 7 weeks ago with inflammatory arthritis, bloods negative RA. Symptoms were agonising for 3 months.. swollen ankle, couldn’t touch it, spent days in tears with the pain. Had chronic fatigue for about a year prior. I had a PRP (plasma rich platelets) injection in my ankle in May. I had OA and plantar fasciitis the latter not giving me any trouble but after the injection I was worse and 3 weeks later my knee swelled massively, my whole leg started swelling. Hospital thought I had an infection. CRP was a massive 150 and white cell count up. Turned out I didn’t have an infection, tested negative to RA again and X-rays the same.
Anyway long story short, I was discharged and still very sick and in agonising pain, could barely walk, stand sit, no sleep because of the pain. I got myself to a large Sydney hospital by which time my other knee had swollen and I couldn’t walk and I was there for 3 weeks. That’s when I was started on prednisone and methotrexate so they basically treated me for RA. My joints were being savagely and quickly attacked, both knees have OA and will need replacing as well as the ankle.
7 Weeks later I have reduced prednisone down to 10mg from today, was on 50 but my knees are still swollen especially if I do too much. I’m still using crutches if I need to walk much. I am taking 20mg mtx weekly as well. My CRP was 17 when I was discharged.
I had a blood test a few days ago which I have not got the results of and I see my Rheumatoligist in 2 weeks so I’ll know more then. At least in not in that agonising pain which was caused by the inflammation. Sorry for the long post but you may have similarities to me which may help you.
I hope you get on top of this soon Frech and get treated properly. So many things you get but the treatment seems to be same. Also I have totally changed my diet, no processed food at all, plant based with a little grass fed meat and plenty of fish. Can only help with the inflammation I hope and I’ve lots 5 kg which is a bonus.
Wishing you the best for a successful outcome soon. Take care.
Oh my goodness it sounds like you have had a horrendous time. I hope things carry on improving for you xx
Hi French, I had normal blood test, my RA shown up in sc no, my consultant said a percentage of people with RA don’t show up in blood test.
My CRP always come back negative, but still have RA dr said it’s not uncommon. Think mine might be Psoriasis RA, since I’ve been taking Methotrexate my eczema has completely gone, one good thing about it. My pain is very well managed on it too.
Well I have managed to get my rheumatology apt brought forward to tomorrow and I’m worried cause I’ve been really struggling but typically today has been a much better day . If tomorrow’s a good day too they not gonna see what’s been going on and get a true picture 😕
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