Hi everyone, I have psoriatic arthritis & was wondering if you can have pain without any swelling or inflammation markers showing on blood tests?
Also, the awful pain I had for 3 months last year is back with a vengeance in my left side, back & front underneath my left ribs. I had a chest xray & ct scan which were all normal, just before Christmas I rang the drs to see if they'd give me prednisolone to help over the Christmas period, as I was in so much pain & not sleeping, this I think kicked it into touch.
Saw the NHS rheumatologist end of January this year & asked if it could be related to PSA, he said it was probably muscular (I didn't think so but who am I to argue)
Forward to March this year & I caught covid, told to stop metoject & lefluminode until I tested negative & all symptoms gone I went nearly 3 weeks without taking metoject & lefluminode, by this time my joints were all starting to play up, about 10 days ago the excruciating pain in my back, side & front returned.
I went for an ultrasound guided steroid injection in my right shoulder last week but the radiographer wouldn't do it as there's a small tear in the tendon so now being referred to an orthopaedic surgeon.
I was really hoping I could have had the injection as at the moment I can't sleep on my left or right side due to the pain, I rang the helpline number & left a message, the consultant rang me the next day & I explained the situation & asked if I could be prescribed some more prednisolone, he's sending me a short prescription out, I also said I'm sure it's all linked & wasn't muscular, he said I'd had all the tests which were all normal, I asked if there were tendons in the rib area (I've no idea lol) & he said yes but the treatment would be the same anyway, I'm guessing he's right & from the tests I've already had know there's nothing sinister going on but feel it would reassure me if I knew that it was all connected.
Anyway I'm back on 10mg of pred for a week then tapering so fingers crossed it gets kicked into touch again.
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Garnacha
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Bless you☹😘..rubbish isn't it...Yep lots of pain Boxes and boxes of pills and potions..staggering around..try this try that.Im the same constantly in pain ..inflammatory markers unremarkable..swelling rare. Bones muscles tendons joints all screaming at you..on and off the bloody steroids..its a crazy thing..consumes your " life " Thank god for family friends and the crazy critters on here..hope your steroids help a bit 🤞🤞.
Aaw, thank you, yes it it 😔 especially when the rheumatologist say's your inflammation levels are showing really low, you feel such a phoney, I don't think they realise how much I / we hate having all these pills and I'm sure they think that's all we're after are more pills, I just want something that works and isn't intruding on everyday life.
They reduced the lefluminode in December from 20mg to 15mg to see if it helped with the neuropathy in my feet & legs, apart from the fact this didn't do anything to help, being on 20mg I was actually starting to see a difference in pain levels, however, the brainfog, giddiness, hangover feeling is the same whether on 20mg or 15mg, I said to the consultant as it hasn't helped improve the neuropathy why don't I go back up to 20mg as long as it's not going to cause any long term damage, he said we'll review this in September at my next appointment! x
That's what I was thinking, dr Google answers & websites indicate it could be, but I assume the treatment would be the same as the meds I'm already on, just be nice not to feel its dismissed by rheumatologist x
Costochondritis is quite common with PsA, I get it alot and it varies in severity.
At times its had me rolling around the floor in pain and other times its just mild, it really is a sliding scale for me.
Where your ribs attach to your sternum and your spine are common areas to become inflamed, just breathing can be really painful.
I find either ice or heat can be really helpful, and be careful not to overdo things . I'm surprised with a diagnosis of PsA the Drs weren't more aware of Costochondritis because its quite a well documented symptom (im not a Dr so I can't say they are wrong 😁).
I do know the 2 consultants ive mentioned it to were really dismissive of it and I felt couldn't comprehend how bloody painful it is, kind of felt like I was being a wus (which I'm not normally ).
Sorry I've totally babbled on , hope you find something to help this pain x
🤣😂😘 thank you, I love how you've babbled on 😘 yes it would make sense but think as the pains not as bad on my sternum they've thought it can't be that, although dr Google says it can vary around that area.Fingers crossed the steroids work again 🙏 x
At least he is still in hosptial Marion. I really hope someone will get their act together soon. It must be such a worry not knowing what will happen. Take care, God Bless, xx
My PsA was missed for 20 years due to entirely normal bloods and only sporadic, visibly swollen joints. At the height of a flare, even in agony with SI joint swelling, a knee the size of a basketball, and sausage fingers, if not below 4, my crp is usually at least still below 10 and my esr always within normal, and my understanding is that being completely seronegative (i.e. normal anti-ccp and RF alongside normal crp and esr) is very commonplace in PsA. It’s also one of the reasons that many PsA patients wait a lot longer for diagnosis than those with RA; the majority of RA patients will display elevated inflammatory markers even if otherwise seroneg. As for rib pain, it could be enthesitis; entheses are where muscles and tendons connect to bones, so there are quite a few within the rib cage. My understanding is that enthesitis is common in PsA, but the treatment is disease control. This link may be helpful:
Thank you Hidden so much, that information is really helpful especially as the gp back in October thought I had pleurisy, it all adds up, I'll save the link (somehow 🤣) to print off & take to my next appointment x
Just want to second everything Charlie said. I have PsA that went undiagnosed for a long time due to negative blood tests.
They still test CRP and ESR to monitor disease activity, despite it clearly not being an indicator for me. I feel like many RA protocols are inappropriately applied to the management of PsA. So things like enthesitis and tendon problems are missed because they don't necessarily show up as swelling. Find a rheumatologist who has a special interest in PsA. Many just treat it as RA's poor cousin.
Thank you, yes it stinks, I just looked up my NHS consultant on Spire hospital and he only specialises in "adult rheumatology with special interest in inflammatory arthritis and connective tissue disease".
There's only one consultant on their site who did her "My MD thesis was aspects of psoriatic arthritis and I have a particular clinical interest in ankylosing spondylitis and the spondyloarthropathies".
That's the closest one listed with any real interest in PSA and obviously she's private.
I have medical insurance that would cover this but, it would feel as if I'd gone behind the current consultants back, in addition, I was under a private consultant until I was able to be seen by the NHS one.
I've asked my hubby to print off what Charlie sent and I'm going to take this for my next appointment, whilst the consultant did say it would be the same treatment I'm on anyway, if they don't believe it is related, when I have a flare in my ribs they're not going to take me seriously and perhaps tweak the meds I'm on.
The other thing I meant to say to Charlie is the information where it gets easier as the day goes on, this is exactly what happens for me if I keep moving, if I sit for a long period it gets worse again, think I need a harness to hang from the ceiling at night so I can sleep upright 😂 x
Apparently yes, as that’s me right now and isn’t it miserable.
Interestingly, the rheumatologist asked me if I’d had Covid as they were seeing a pattern. I hadn’t knowingly had it, but may have been asymptotic of course.
I’m about to beg my gp for a third course of steroids. Having an MRI at some point. Rheumatologist have put in an urgent referral but not heard anything as yet but fingers crossed 🤞🏼🤞🏼🤞🏼🤞🏼
I mentioned an MRI and he said that "The Team" didn't think it would be of any benefit as the treatment would be the same anyway, just be nice if they could confirm if it was related, I don't think they realise how much it impacts our everyday lives, the GP has exhausted the tests he can do (as far as I know) so it's where do you go from here if the rheumatologist isn't helping x
I guess when you see so many people with similar issues, you tend to become immune to the effect it has on people personally and stick to evidence-based medicine. It's hard though isn't it when you wonder if this is how life is always going to be x
I actually have RA, but for a year now it’s settled in my hip, no more swellings of the smaller joints, my CRP is and always has been normal, my ESR though is off the chart in the 100’s.
My Rheumatologist is always saying, no swellings? 🤔 CRP normal? But since my appointment last week she actually said the immortal words, well....just goes to show you, every patient presents differently!!!
To cut a long story short, she sent me for a nuclear bone scan of my hip which showed up inflammation, then urgent referral for an MRI, in the meantime she did an urgent referral to Clinical Haematology to check for blood cancer due to my high ESR?
Anyhow the severe inflammation showed up in the MRI, this was the only way she was satisfied and gave me sulfasalazine to add to my Methotrexate and a steroid injection. This has all taken 6 months, I’m concerned now there is permanent damage to the hip area.
If your pain in the ribs carries on, maybe they can do an MRI? As others here have said, it may be costiocondritas (excuse the spelling 😂) but then again it might not. I also have a tear in my shoulder tendon, which is actually more blinking painful than my arthritis at times 🥴
Oh no, poor you, considering how important it is to treat the disease before any lasting damage can be done they don't have drag their feet, it's awful when you have a gut instinct but they won't listen and lo and behold you were proved right, I'd love to say ne ne ne ne na😂 x
Hello I have had GCA and then Breast Cancer in remission now. I have also had osteoarthritis in my ankles and knees since 2016.
Back then I saw a Rheumatologist who put me on various dmards all of which could not tolerate Methotrexate Asathiopine or Leflumonide was due to go on to Tocacilizumab for the GCA and couldn't do so because because the breast cancer was found when taking the tests to go on it.
I had also been on steroids for a long time at high doses but found it very hard to wean off then as I would flare up and have to go up again.
Eventually after slowly slowly reducing when I felt ready by very small amounts ie 1mg every couple of months this worked after two years I came off steroids but all the pain came back in anger.
I was then diagnosed with Psa which I think I'd had for a long time and not been diagnosed .I had pscorisis in my head for as long as I could remember shoulder pain which I'd had steroid injections for ankle pain terrible Achilles pain fat fingers and sausage toes pitted nails and could not get my toe nails right with what ever lotion I tried
Eventually I tried Apremilast / Otzela which is you take two a day one in the morning and one at night. This is a dmard which is for Psa
It did give me diarrhea for a couple of week but not the terrible side effects as from the other dmards I taken and been terribly ill with and which I couldn't tolerate previously taken.
It works about 70 percent and has numbing effect on the PSA you can still feel some pain but it has enabled me to sleep at night better and get around in the day without the excruciating pain.I used to have. It has also has improved my toe nails which where awful and has cleared all the pscorisis I had in my head which I've had terrible trouble with for years .
I have found it much more effective for PSA than any previous drug I have taken .
Yes I've got a huge dent in my thumb nail, my left toenail has got a huge split in the middle and none of them are very pretty anyway 😂
It seems that most rheumatologists only specialise in rheumatoid arthritis, I'm going to start making a note of things to take at my next appointment such as, normal CRP & ESR levels can be normal, you can have pain without any swelling, nail problems and take the document Charlie shared with me.
I'm so glad you're in remission and that you've found something to help with your PSA x
Could that be to do with your liver? I've got to be honest, if I've had more than the 8 units of alcohol in a week (I don't usually but do like a glass or 2 of wine on the weekend) I get a pain just under my ribs on my right side and always think it's my liver telling me to lay off the alcohol x
OMG! This is the first time I have posted here, but my new Rheumatologist (my old one passed away as his vehicle was swept away in the recent floods here in Australia)has narrowed down my symptoms to Psoriatic Arthritis, once again normal CRP and ESR, very little swelling, but terrible joint and tendon pain for the last year.I have been bothered by intermittent lower chest and back pain (more like a stitch that takes your breath away when I bend over) and this has been getting worse and worse over the past two months. I was even admitted to the hospital for possible heart failure, and also given the diagnosis of new onset asthma. I have had countless CTs, echocardiograms, chest xrays, and lung function tests. Keep in mind that although I'm 61, I was somewhat of a distance runner prior to this hitting me April 2021. Anyway, I think this new Rheumy has hit on the fact that all my rib pain, mostly back but some side and front, and my subsequent shortness of breath is all due to psoriatic arthritis. I had been on MTX, Hydroxy, Pred 5mg before seeing her, but she added Humira recently, which is almost impossible to get biologics in Australia, as inflammatory markers is part of the criteria. Within a month, the rib pain is almost disappeared, and I believe that some of my other joints and tendons are feeling the slightest bit better as well. I think that the rib and chest pain of psoriatic arthritis is glossed over sometimes, as there is nothing "red and swollen" to examine, but it is certainly very disabling. I can only have hope that this treatment will continue to make a difference!
Yes my GP told me that he thought I had bone cancer! this was after the results of the CT scan were normal but it didn't have frighten me, I was basically told then that they've no idea what it is and more or less to put up with it, it was only me asking at Christmas if I could have some prednisolone to help over the Christmas period as I was in so much pain that seemed to kick it into touch, as I said, the rheumatologist told me in January when I first say him and the pain had somewhat alleviated by then that oh it's probably muscular.
I'm putting 2 & 2 together as it seems such a coincidence that when I stopped MTX & Lefluminode due to covid that the pain came back, I also had to stop MTX in October when I had a chest infection which is when the pain first materialised, at first the GP diagnosed pleurisy.
I'm so glad you're new rheumatologist is on the ball and fingers crossed the new treatment will continue to help x
Thanks for that Garnacha. I'll certainly save this thread and keep you updated if we discover anything new or exciting. I haven't had Covid yet, and I'm a little worried how my ribs will fair with coughing, etc. I guess I'll cross that bridge when I come to it. Nice to meet a fellow PsA sufferer, and exchange experiences and treatments. Have they suggested starting you on biologics yet? My Rheumy did say that conventional dMARDS are not as effective with PsA as they are with RA, due to the extensive tendon involvement. Good luck to you in the next while, keep your hopes up!
Aaw thank you & likewise 😘 when I was seeing the private consultant whilst waiting on the NHS list he said that he thought I'd need biologics which is why he was keen for me to be seen on the NHS, the NHS consultant doesn't seem interested in those (at the minute 😔) but I'm hoping that armed with more info for my appointment in September he may come around 🤞 x
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Rib pain
Pain in left side under the rib
Is it possible to have RA with no joint swelling or joint pain?
