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can you have a flare up with pain of RA without raised ESR OR RHEUMATIOD LEVELS.

i was diagnosed with RA last year and have been very lucky with minimal pain recent pain levels,stiffness and fatigue have increased my bloods are all fine .can this bee a flare up or somethingelse going on. This is my first question on the site.

12 Replies

Hello Cinders

I'm afraid I can't say anything about the medical aspect as I'm not qualified to do so.

All I can suggest is that CRP and ESR are generally measures of inflamation (flare) but not always the complete story and I definitely also feel the symptoms you have described even when my bloods are at acceptable levels.

It doesn't necessarily mean I am having a full blown flare, it is just part and parcel of the disease.

However, if your pain levels, stiffness and fatigue have increased it is definitely something I would suggest you speak to your GP or rheumatology nurse about.

You will get to know and understand the changes in your body but early intervention is always the best option.

I hope you get a lot of help and support from this forum. I certainly have.



Judy thanks for the info i wll speak to my GP.



Hi there. A lot of us seem to find that the blood levels and how we feel don't match, but over time you get to know how your own body reacts and work out when to seek help and what's just 'normal' RA for you. My blood rarely shows much difference between when I can skip about, and when I'm totally laid out whimpering. But if this is a change for you then best to flag it up with your Rheumy dept as may show that the meds you're on need tweaking, or even thtthere's something else bubbling up. I wouldn't worry, but just try to get looked at. Polly


Thanks polly will get speak with my GP. Cinders


Hi Cinders and welcome to the world of support, questions/answers and advice.

I agree with Polly my bloods rarely reflect how I'm feeling physically. Other conditions, infections or even the contraceptive pill can affect blood values, a good Rheumy looks at the whole picture especially the level of pain/discomfort someone is in.

You know your body so it's up to you to tell them what's going on.

In fact my GP takes very little notice of blood values especially as I have other conditions which affect them.

Also, I've noticed over the yrs my physical health depends on the amount of stress I have and how well I'm feeling mentally. Yet my blood values stay more or less the same even during severe painful flares.

Go have a chat with your GP, he could give stronger painkillers or even check you out for other things that might be making you feel poorly.

Hope everything settles down and you feel better soon.

Beth xx


Thanks beth,so far everyone has been so supportive on this forum i guess it helps to know what others are going through.



Hi Cinders - I'm in the opposite position where my ESR is always raised and last time 2 weeks ago was 62 even though I was feeling fine and have no other health conditions that could be responsible and now viruses. Yesterday it was 50 and my average is about 48. Maybe I just have a higher average than most people so my reference point should be raised I don't know? I suspect it will be disregarded because when it was at 62 I was almost pain free and yet a few weeks earlier when it was at 30 I was have a mini flare up and felt stiff and achy all over. This suggests that the inflammatory markers are pretty meaningless to me unless they are telling a story that means something to the rheumy but not to my body - if that makes any sense?! I think it's pain and symptoms that are relevant though. TTx


Thanks Tilda T looks like the reference points dont necessarily give a true pic of whants going on in out bodies .



Well that's really what I want to know Cinders - I want some assurance that if my markers are still pretty high (and I realise they can get much higher than this too) then is the MTX and Hydroxy mix doing it's job? Last week aside it feels mostly as if it is but might low level aches and pains with high inflammatory markers still mean that the disease is active and the drugs aren't enough for me?

That's my main question but I don't know if he will be able to answer it or not. But I really don't want to be worrying about this forever as my ankle still hurts all the time and my fingers will still not clench although i only get the odd ache or flash of pain now. Maybe all that is just normal RA wear and tear and an increase or a change in meds won't make it any better though. Oh well I'll know more in about 6 hours time I hope! TTx


Hi Cinders, is it possible that your medication, ( you don' mention what you take) is affecting you, but keeping your bloods ok. I am in this predicament at the mo, I am on abatacept, which keeps my bloods good, but I feel miserable.

I agree with everyone, go talk to GP or consultant, take care. Jennyxx


thanks jenny


Did they take your CRP levels? Sometimes, they'll be elevated without anything else being up, because they respond a lot faster to acute inflammation than ESR. Also, it's worthwhile considering if you have something like fibromyalgia, which can make you feel awful, drained, and in pain, without having any effect on your bloods.

Hope it improves soon!

Sara x


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