Does a patient have to be in pain for inflammation to be present in the joints including spine?

[Celticdancer]

I was wondering if inflammation still occurs in the body especially in the joints, spine etc even if a person does not have any pain or swelling or is inflammation present only when you notice pain and swelling?

[Hidden]

My understanding is that, whilst pain and swelling are the most common indicators of active inflammation, it is possible to have inflammation that isn’t obvious like that. It’s often referred to as silent inflammation, and is common in the early stages of a joint being effected. The most accurate way to pick it up is usually via scan: when I was diagnosed, I had visible swelling in some fingers, but the ultrasound done to determine the nature of that swelling also found inflammation in my wrist, even though that wasn’t swollen or sore at the time. Two years on and having not got my disease under control in that time, that same wrist is now quite routinely swollen and painful. This is because silent inflammation tends to occur early in the disease process and therefore often progresses to pain, swelling, and stiffness as the joint becomes damaged by chronic, low level inflammation.

Depending on your diagnosis and whether or not you’re seronegative (meaning some or all of your blood tests are normal, even with active disease), blood markers like crp and esr can also indicate the presence of underlying inflammation in the absence of outwardly visible signs for some people, although these are not specific for joint inflammation and can be elevated in a wide range of situations, including with a simple virus or other infections. That’s why they’re not used in isolation, and scans are the preferred way to evidence that joints are inflamed. Often this is via ultrasound as it’s quick, easy, and relatively cheap, but for the spine, MRI is often used to demonstrate whether or not there’s active inflammation.

[smilelines in reply to Hidden]

Hi do you know if an X-ray shows inflammation? My doctor said that an MRI will not show inflammation and that it is pointless yet it seems like many on here have had MRIs. It is just frustrating as I am not able to access how I am doing as I don't see the inflammation or if damage is happening.

[Hidden in reply to smilelines]

My understanding is that x-rays will show any permanent joint damage that’s the result of (usually long term) active inflammation, along with large effusions, which is the collection of fluid around an inflamed joint. Like if you have a football sized knee, the fluid causing that would show up on an x-ray. They don’t show more subtle inflammation because it’s in the soft tissue and fluids lining the joints, sometimes deep inside the joint itself, and (with the notable exception of the lungs) x-rays are most useful in imaging hard tissue and bones. There are features of long term, chronic inflammation that can be visible, where it’s eroding joints, narrowing spaces within the joint, or you’ve got bone spurs forming, but that’s all permanent damage from unmanaged disease. Ultrasound and MRI can both pick up inflammation at the earliest stages of joint involvement - like my wrist two years ago, where at that point there were no outward signs at all. MRI in particular can also pick up historical signs of previous inflammation, which is how my recurrent ‘weak back’ from age 16 was finally correctly diagnosed as arthritis flares in my SI joints at the age of 36. MRI can demonstrate the bone changes that x-rays pick up, but x-ray can’t pick up the soft tissue changes that an MRI can.

You might find this link to be helpful:

medicalnewstoday.com/articl...

Honestly? If it’s your rheumatologist telling you an MRI doesn’t show inflammation, then I would very strongly suggest you consider finding a different rheumatologist.

[smilelines in reply to Hidden]

Thank you for your clear and helpful reply. After reading the article and reading your comments it seems like an MRI would be a good tool and she is just not ordering it because of the cost and wait times and maybe because she is confident with feeling my joints. She said we would take an X-ray if I am having a specific problem to look for damage. However, I would like to know if my inflammation is controlled before I end up with permanent damage, especially in my back. Thanks again for your reply.

[Brychni]

Hi C

Yes, as Charlie_G has said there doesn't even have to be swelling. My Undifferentiated Inflammatory Arthritis was diagnosed with an ultrasound on my wrists which, at the time were not even hurting. In fact when I went for the scan I felt like a fraud and thought I had been sent there in error. But that's where the synovitis was seen and I was told that it would be the reason for pain in other joints.

[Maloc97]

No. MRI detected inflammation in my spine without any pain at that time. If you've not had an MRI on your spine yet but its been recommended to you, get the scan.

It takes a while to scan from the base of your skull to the base of your spine but gives them a complete image to examine. Nothing happens during the scan, it's just boring, a bit uncomfortable lying on the "table" & very noisy.

Best wishes!

[zen4]

Yes I would agree Your first reply is excellent and explains it well. I had RA at 23 and it started with a lot of pain in the wrists and fingers and toes. After that I had periods of remission without any meds and little sign of RA except after the birth of each of my daughters. At 38 I went on meds but by then there was lots of damage in my wrists, fingers, elbows and feet and I was not aware it was happening as I did not have consistent or extensive pain. Even after being on sulfazalazine I still had a lot of stiffness but not any real pain and yet i was still getting gradually more damage according to later x rays. In those days you couldn't have ultrasound or mri scans to see what was happening and it was only evident that there was inflammation by the esr in the blood tests. As the new biologics came in during my 50s I was never noticeably having enough flares that could be picked up on my appointments and so did not qualify for the biologics. It took me until I was 67 and even then the consultant had to be creative to request it as I have always had the type of RA that gradually erodes my joints without too many flares. In answer to your question yes damage can happen without huge flares and lots of pain so ensure you get your regular blood tests and if you have some pain or a flare get scans

[smilelines]

Thanks for asking this question. It seems this disease can be very sneaky. My doctor checks for bogginess in my joints. She is able to detect inflammation when everything looks fine and I have no pain. This makes it hard though because I have no idea how I am doing and if my inflammation is controlled. All I know is every time I go I am told that my arthritis is still uncontrolled and given more mediation.