How much does a bit of swelling without any pain matter?

As I have just written at the bottom of my last blog post - today my OH noticed that my knuckles on my right hand and my finger joints (middle ones) are swollen again as they were a lot last year when I was diagnosed. Only this time I have no pain - but this morning they were very pink and hot to the touch he told me. I also find that the undersides of my knuckles ie the areas on my palm ache slightly and sometimes throb a bit nowadays but I've been assuming that is because I have some wear and tear arthritis going on in my hands too and they feel tight often. This isn't important enough to bother the GP with (I have no rheumy nurse) I know but just wondered if swelling matters much if it isn't accompanied by any pain? I will get my ESR taken at my monthly blood test on Monday with the nurse but sure it won't be above my normal rate of 30 as I feel fine otherwise. I'm horribly tired just now but I think that's down to the weather and Ruby the new puppy!

16 Replies

  • Sorry im no use whatsoever as everytime i get swelling ive usually had an enormous amount of pain first?

    My pain is always either before swelling or both alongside each other.


  • I know Josie its weird - that's always been my experience too - generally speaking a lot of pain and at the end some swelling in the past - but what might it mean the other way round i wonder? Nothing much is what I'm hoping but just wondered if others have experienced this at all. Also my veins in my hands are all extremely elevated? TTx

  • I have similar ie little pain but swollen knuckles that almost look bruised. My rheumy nurse (on monday) said it showed active disease, but my bloods were OK. Consultant took a look and suggested ultrasound scan to see if it was inflammation of joint or not.

    This might not be useful as I still havnt got definate answer - but it shows we should not ignore any changes.


  • I would be happy get swelling with no pain!

    Just wish i had what you have!


  • Yeah that's what I've been thinking since pain vanished around June time - and it's easy to say Josie but what if this is a bit like cancer - i.e no symptoms and just doing it's dastardly gnawing thing without me even feeling it? I'm not actually that bothered by pain (have a very high threshold) or swelling to be honest just by consequences and the prospect of not having functional hands one day soon. Last year the pain in my hands and wrists was often horrendous but I found that it helped me to treat them with great care and respect - pain as guide for how to use them rather than abuse them. Now I'm just forgetting that they might not be as robust as they feel if you know what I mean?xx

  • I'm one for taking photos when there is anything visible going on, just for the record. Also, perhaps ask the nurse (at the blood test time) if she could report what she sees to the rheumatologist on your behalf. Is it anything to do with the cold? Try keeping your hands extra warm and see if it makes a difference. The fact that your veins are also elevated makes me wonder if its not an RA flare, but more to do with either the cold, or your hands going from cold to warm a bit too quickly (changes in blood flow, etc) when you come in from outside, etc. Worth keeping an eye on though, and if you do think its a flare of inflammation see if you can get some specialist advice through your GP quickly so it doesn't go out of control.

  • Thanks Earthwitch. After my blog I feel I've accepted that I do have RA really again but as this is painless it is a bit strange. I don't think its the cold because I'm at home all snug now and have been wearing thick new gloves that keep my hands snug. Funnily enough I've taken a couple of photos tonight.

    The nurse is only our practice nurse and has no knowledge of RA or any contact with my consultant - she just takes my blood. It would be my GP that would contact him if anyone and I don't think its dramatic enough for that and certainly not a flare as its painless. I was just wondering if it can be active RA inflammation if it doesn't hurt at all just feels tight and a tiny bit achy. I think I'll just ignore it for the time being. That's interesting about the veins re temperature I don't know that. Tilda x

  • Hi Tilda, my knee was swollen for about nearly 2 months with no real pain (it was a tad uncomfortable but thats all.) Mentioned it to my rhumy nurse and she was keeping an eye on it. All this time my bloods were good so they didn't seem worried, but offered no explaination. In the end, the dr. was concerned that it was swollen for so long, so I had a steroid injection in it that really helped. So my guess is its just general inflamation that comes with RA. Sorry I can't really help, but just wanted you to know that you're not the only one with this! Just keep an eye on it - and if it continues go see your gp (its better to get it checked, and it will save you worrying!) Take care, Tracy x

  • Hi Tilda, I sometimes have swelling without pain. Usually my ankles swell and are a tiny bit achey so i dont worry about it. That ususally happens if i stand ironing or cooking but it quickly returns to normal after rest. The hot weather is my enemy the swelling lasts longer and my knees join in. last spring i had a steroid injection because the swelling and stiffness in my knees just wouldn't go away. At the moment when i awake my fingers are swollen but again this doesnt last longer than an hour or so. I think if your joints are hot and swollen that is probably a sign of inflammation and maybe worth a mention to your gp. Good luck xxxx

  • Thanks Treesha - that sounds more like Oedema than RA swelling if it comes in heat around your ankles? I sometimes get that too in warm weather and used to get it a lot in pregnancyy. This is different because it's cold here not in any way hot and it doesn't seem to be about the weather or fluid retention. I too usually find my hands are a little swollen and stiff on waking everyday but I'm noticing that two of my knuckles and a finger are constantly a bit swollen now. It isn't a big deal - such a small thing really but it's my right hand (and I'm right handed) and I'm keen for it not to go backwards or for any damage to be going on structurally. I've never had any ultrasound, MRI or x-ray for any part of me yet but this hand is the most disgfigured (and only a bit) of all my body parts by last year's constant pain and swelling so I think this is just the legacy of that time probably. I reckon no pain has to be a good sign at least! Tilda

  • Hi Tilda I have had swelling on the back of my right hand recently without any pain and it settled within 48 hours. You say it is not around a joint but you have many joints in your hands so it could be worth mentioning to your dr just in case

    hope everything is ok


  • Yes thanks Cris I'll mention it if it stays or gets worse after Xmas when I next plan to see my GP. The veins are really huge around my right hand forefinger knuckle and I've just noticed that if I compare the shapes of both hands from the sides two of my right hand knuckles are clearly bigger than the equivalent on the left hand so I think there have been things going on while I was happily unaware of it in my pain free remission wallowings! But just not sure that this is RA or OA wear and tear which my fingers seem to suffer from anyway since the RA started. TTx

  • Hi Tilda,

    I have noticed that when my elbow, wrist and fingers are playing up that my veins are enhanced and very 'blue' looking on the hands. As to regards, pain it is not as similar of before medication, I get more stabbing/fizzing ones now, that completely take your breath away, and you screech out spontaneously . I normally use SUUUUUUUUUUUUUUUUUUUUUgar, then either hubby or daughter say which area or was it that bad? Before laughing at me! I think it's to make me laugh rather than cry. Otherwise I just get a dull ache in the areas that I know are protesting at the moment, but not bad enough for pain killers. I do know my pain threshold is high, so others may well take some tablets, like hubby!

    Speaking of hands have you noticed whether or not your hands have gone into skeletal mode near the knuckles, where you had previously had inflammation, you have to make a fist to see it. If not then I think it must be old age creeping up on me. Take care. xxx

  • Well I'm not sure Georje re the skeletal mode? I have only really paid much attention to them since the RA began - which was very much in the way that you say yours is now with breath taking stuff. Sometimes wonder if that gave me a very strange view of RA pain because nothing else since has quite compared - even when my knees and my ankle all got very sore and swollen - it wasn't the ouch suuuuuuugar stuff so much as made me hobble about feeling old and grumpy. My knuckles on my right hand look really high - like mountains with big round pink peaks and the veins like swollen rivers about to flood at any moment or maybe they are glaciers actually?! I too have a very high pain threshold and even when experiencing lots of it I tended not to take pain meds much even though I was instructed by GP to take NSAIDs.

    I think also that I've been formed by a life time of eczema - especially on my hands - and even with lumps and bumps of arthritis they look relatively bonnie to me now - no huge gaping cracks seeping and so painful - yippeee - actually that thought has just resolved me to stop worrying about my swollen knuckles right here and now!

    Anyway hubby has taken car and Fred off to get some winter tyres because he slid into a granite slab on our steep driveway yesterday so I might have to take Ruby somewhere and sneak a nap because I've been wiped out since the moment she woke me at the respectable time of 7.15 a.m. xxx

  • I had swollen hands with no pain for at least 10 years before I had my first real flare of RA. I went to my GP and he showed little interest at the time because of the lack of pain. My X-rays show no joint damage.

  • Well it's very good that you have shown no joint damage at least Emn. I had no joint damage when my hands were x-rayed in June 2011 but not sure if anything's changed as they suffered a lot more after that and no x-rays have been taken since. My GP tells me it's unlikely that x-rays would show any damage yet but they have changed shape a bit since those first and only x-rays were taken 18 months ago. I guess it's likely that swelling would only be destructive if there was pain too - and are some flashes of throbbing pain sometimes now but nothing like how they were a year ago. T

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