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Symmetry of joint involvement?

My left ankle has been sore now for about 6 weeks without let up. Wondering if it's RA or not - since I've no specialist to ask I have no idea really. My other foot is sore in the ball of the foot but it's less noticeable and this makes me wonder if this is RA or if I twisted it sometime. Also my elbow is sore on left side as well and it hurts when I stretch out my arm fully or pull it in fully right on the bone and the whole arm is achy including the shoulder and muscles. Again I know that in the past i've only had symmetrical pains so I'm a bit muddled as this is quite moderate pain and only really hurts when I move these joints - much worse first thing in morning. Wondering whether it might be OA rather than RA actually but I have no idea how the pain differs with these two diseases. None of the pain produces anything visible re swelling or heat although my ESR was up at 50 when last checked. Advice based on experience anyone?

18 Replies

I think it needs to be both, I'm probably wrong though lol, maybe you have some OA too as I have. Hope you feel better soon Tilda.



I've never been symmetrical, and have a roving mix of left & right side joints that swell/hurt and generally give me grief. So I don't think it's an absolute must that you get symmetrical joints flaring.

Also, I read that the main reason that feet aren't included in the DAS28 assessment is because they don't swell or puff up in the same way as other joints so it's much more difficult for docs/nurses to distinguish whether they are or aren't affected from just looking and prodding them. And my feet usually hurt like crazy but look perfectly normal. When my elbows go, they also don't show much sign of being swollen but there is often a tender spot when I prod them. In fact, thinking about it I've only ever had swollen hands & liquid filled puffy knees! Everything else has just been painful.

I only have OA in one joint - a knee - so no expert but it's a different type of pain. It developed very slowly over years, unlike the RA joints which can go from nothing to awful overnight. Much more graunchy, and more of a sharp pain when I do things (like walk!) rather than the RA constant achy pain that gets more achy when I do things with the joint. But both RA & OA joints are worse first thing.

With an ESR of 50 I reckon that the most likely is RA.....if you've never had any signs of OA before then why should it suddenly pop up in weeks? Px


I always have it different in both sides my right side tends to be worst.

I've had trouble like your explaining in my left foot for months now, I'm told by podaitrist that its a mix off ra and plantar faciatis this is the reason for getting worse in the morning. I also have increased pain in my left arm, which I've been told is refered pain from holding myself up on sticks trying not to put pressure on my foot.

Hope you get some answers soon.

Take care x X


Oops sorry I didn't see you there RF - hope you're well haven't seen much from you lately? Interesting that you also get it in different places on both sides like Polly and I do. Mine is outer ankle bone so I don't think it would be plantar faciatis although I do have pain and I've banged on about it before here I know but I keep expecting it to go away like other pains have done but it's not shifting nor is it becoming unbearable. Should I ask to see a podiatrist - not even sure there are any up here?! I don't use sticks so can't be that bad - although I wouldn't like to use sticks with my wrists the way they often are as might make them worse too! TTx


Meant to say although I do have pain in my feet quite a lot too.


Well I don't know Polly - I guess like Philip I assumed that it had to be symmetrical to a certain extent if it's RA? But it's interesting hearing how it is from someone who has experience of both.

I have a bit of OA in my fingers I think - in the top joints of each finger I have a Hebedian node or two and they hurt a lot as they spring up in a stingy sort of way and then they don't hurt much at all once the node has formed. They only started when the RA had taken hold though. I was told they were probably OA by the rheumy first time I saw him anyway and have read about them and it seems to tarry but I read somewhere here on NRAS that OA is a secondary symptom of RA for some people.

I'm just not experienced enough in the variations of this disease yet to know and my ankle isn't very painful like my wrists and fingers have been in the past - but just continually sore. In the past when knees, ankles and wrists have hurt they've peaked, swollen and gone red hot briefly and then it seems to have burnt itself out and they have been fine again in the morning. Or, like my fingers and knuckles they've just been continually stiff and a bit swollen.

So this constant pain in one ankle seems different somehow but maybe it's just that the MTX is dulling it down a bit - I really don't know - but just thought I'd ask as no one has examined or X-rayed it and it's just always there now so it makes me hobble sometimes - which is a bit embarassing in a small place I find. TTx


Hello Tilda

Sorry to hear your still having probs. OA or RA That is the question! i have an other one for you,my Doc says mine is probably Inflammatory Arthritis but no explanation.Consultant said OA in top joints of fingers,I still havnt got a diagnosis yet. What I find is very helpful is using a wheatpillow on my feet in bed and they feel much better in the morning ,not as painful! Keep your arm +shoulder moving I had frozen shoulder a which was awful.How did the choir trip go,hope you had a great time



Oh dear Pat I don't know how you cope without a proper diagnosis you must be very calm and patient compared to me! I do keep my shoulder moving and have had much worse than this in both shoulders in the run up to my diagnosis so not really moaning - just wondering what's going on. I last saw rheumy 5 months back and am told that next apt is in end July which means it will have been almost 9 months since I last saw him - unless GP manages to persuade him to see me sooner somehow - so I get a little frustrated by not having anyone I can ask about symptoms apart from GP who never examines my joints any more now.

Yes choir trip was great - a bit exhausting on the Wednesday because of 8 hours spent hanging around in an old miner's hall in Cumbernauld but it was lots of fun too. Felt like I was returning to RA world when we did the last lap of the return journey but I wasn't the only one who went a bit quiet and morose.

Came home to find liver is slightly raised and am not sure whether it's down to the booze (x3 g&ts and a bit of wine) or the MTX dosage raise. Still at least I know roughly what I've got and am on some medication - I think it's the hardest thing when you're in limbo. You have my admiration and sympathy. TTx


Hi Tilda i have the same problems with my elbows they ache and if i carry bags ie: fully straighten them with weight attached they are painful. They ache if bent too long in the same position such as texting. As far as feet go mine do swell A LOT as well as my knees but my knees are not as painful. I think its probably RA you have but im no doctor. Glad you had a good time away and a cheeky couple of glasses of alcohol. Take care and good luck with reducing meds, mine has just been increased!! Xxxx


The swelling could be oedema (sp?) Treesha - especially if you are taking anti-inflammatories? Mine got very swollen when I was on the Sulpha.

I should have said that my ankle's not really painful unless I put my foot down at an awkward angle or try to balance on it and then it's really painful. So uneven ground or walking on slopes (I live two thirds of the way up a steep hill) is really hard going I'm finding. And the pain is sharp but not burning hot like my joints were during previous flares. I can't bend my toes very well any more ever either and that's in both feet. I think it must be the RA but it just feels like I've twisted it and it doesn't seem to come and go like other RA pains have done in the past.

I've decided to take the MTX at 17.5 mgs this week again because my GP told me that the liver was only slightly elevated and if I get my blood tested again a week tomorrow then it may turn out that it goes back to normal once the brief alcohol episode has been flushed out. I feel I've got through the discomfort barrier to reach this dose and it would be a shame to drop a dose if I don't have to. TTx


Hi T

I've got ankle pain outer left ankle bone pain since friday. Never had it before, also my right elbow is like how you described your left elbow, I also experienced right hip yesterday that was also new and made walking very different as when you walk your hip roll and every time I walked I experienced pain.

My pain tends to be on both sides when its bad, but predominately on the right side is always worse as I am right handed.

Thus apart from my left ankle I still am experiencing soreness in right hand, knuckles, both knees, but worse in right.

I see the gp on wednesday and will discuss with her then.

For me the latest round of acheyness ends the two wks run of feeling reasonable well. They say good things never last, but I did enjoy the freedom and ease of movement it brought.

Take care T

Sci x


Let's hope that someday soon your medications work well enough to give you more than two weeks of being relatively pain free then Sci. It feels so unfair when the pain-free holiday ends doesn't it?

Yes that's a weird coincidence about our left ankles isn't it? Mostly it's worse in right hand joints for me too - especially wrists and fingers - although not the elbow. Pinkies on both sides are stiff and swollen most days now and stick out a bit. Maybe I over compensate with my left side for some things.

My ankle is worse today after walking about 4 miles over rough terrain as part of an art event yesterday. I ended up sitting on my foil survival blanket while others clambered. A couple of brisk looking elderly women came up to me and asked me if I was okay. I said a touch of arthritis and they looked suitably disgusted but sometimes it's just not worth explaining RA is it?!

Lately my ankle hurts in bed in the night too when I move about or lie on the ankle bone and is definitely getting slightly worse all the time. So hope I get to see a rheumy soon because I really do want to know if it's damage that's already occurred or whether it's active RA or possibly something different entirely - although I think that's unlikely to be honest. TTx


Hi everyone. I have had ankle trouble for a few months now and they gives way sometimes - I will ask to have them x-rayed. Just had my upper spine x-rayed (due to hot searing pain between shoulder blades) and that has shown damage so am waiting to hear the details but this post has made me think about ankles more. My joints do ache symmetrically but right hand much worse. Always plenty of food for thought in here - thanks for this Tilda! Will be back when better.

Julie x


Yes that sounds really tough for you Julie - it's always worth asking questions of everyone here - such interesting replies! Take care and come back when you feel up to it please. TTx


Hi Tilda,

I never had symettrical? (no spell check sos) pain, sort of always random. I think with your elevated ESR you can assume you have inflammatory arthritis, RA. My right ankle, and left knee, and right wrist, were my initial problems now I can get an ache anywhere.

I think particularly at the moment, I am quite sore, not sure my last Humira injection went in right and I am hoping it is that. Or else worse case senario, the Humira is not working anymore :(

I am seeing my Rheumy on 1/5, and she will review all on basis of bloods. I am seeing GO & ENT Consultant this week, its a non stop merry-go-round of visiting docs. Roll on June when I will be lolling by a pool in Portugal hopefully.

It is an awful disease by times, and when you feel bad, its like you are always like that, but for me that is not the case and I am usually Ok.

Take care, Gina.


Meant GP not GO!


Hi all

Just to add to the debate and hopefully confirm some things, RA isn't always symmetrical.

As you will all know better than I do, in living with this disease, it is very varied, but there are some common trends. Symmetrical joints are something that will often be a good clue to it being RA, particularly when they are looking to diagnose, but it will not be the case for everyone.

Similarly, not everyone struggles with stiffness in the mornings, and some people say they don't get fatigued, while for many this is one of the main symptoms they deal with. So, everyone is different, and you will not always display all of the 'classic' symptoms, like symmetrical joint involvement.

Hope that helps!


(NRAS Helpline & Information Coordinator)


Thanks Victoria - yes it does help because I was thinking this must something else - although today I'm 100% symmetrical in that every joint is stiff and aching!



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