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Old 06-27-2012, 03:45 PM   #1
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Can you have RA, have a swollen ankle but with zero pain?

What does everyone think?

This is where I'm at. I went to an orthopedic who said based on x ray it is not OA, and now is thinking it's rheumatic. However, he ran the following:

CBC = normal
RF = normal
ANA = normal
Sed Rate = normal
CRP = high normal at 8.2, but I've had 9.4 one year ago and my endo didn't think it was anything, and said he suspected it would come down, it did.
Lyme test = normal
Sjogrens tests = normal

My primary looked at my tests and believes it is something other than rheumatic disease because:

1) Tests are normal
2) I do not have ANY pain in the ankle, just diffuse swelling, zero pain.
3) She said it's usually bilateral or more joints would be involved usually.

I am seeing her in one week. The orthopedic refuses to even get an MRI. He wants to push me off to another specialist. I am just going to go with my primary and see what she thinks on exam and go from there.

Oh, I also had an ultrasound to rule out a blood clot and that was fine.

So I am wondering if this ankle could be RA even if I have zero pain? When I went for my ultrasound at the ER last Friday the ER doc thought it was a generalized edema in the ankle and thought possibly dietary or something like that. He never even mentioned inflammatory arthritis!

What does everyone think? Wouldn't I have pain in the ankle? Or more symptoms or something more off in the bloodwork?

 
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Old 06-27-2012, 08:03 PM   #2
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Re: Can you have RA, have a swollen ankle but with zero pain?

I can only say from my exerience-i was diagnosed with Sjogren's. When my joints swell they hurt. Usually its bilateral, meaning both shoulders, wrists, knees, ankles, etc. But i don't have RA, only Sjogren's. Had the x rays and body & bone scans all before my final diagnosis to rule out other auto immune. My rheumy missed my diagnosis-i finally insisted on a lip biopsy because my blood tests only showed high SED but only when i was having a flare up of inflammation. Follow your gut feelings & find a dr you trust-sometimes it takes a while to put all the pieces of the puzzle together for any auto immune diagnosis. Wish u the best.

 
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Old 06-27-2012, 10:32 PM   #3
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Re: Can you have RA, have a swollen ankle but with zero pain?

Thank you so much for your reply.

You are so right about trusting your gut. My first impression of the orthopedic is it's out of his field so he is pushing me to someone else. He told me initially if the bloodwork was normal, he would get an MRI or check every other avenue for the swelling. The bloodwork came back essentially normal and then he went against what he originally said, and claimed I still need to see a rheumatologist. My family doctor does not suspect I have an inflammatory arthritis but she said she has to see my ankle, rule other things out, and go from there. You could tell she disagreed with the orthopedic. She just said the picture doesn't add up, but then said she wants to see me and maybe it does add up, she doesn't know just yet.. she just knows she doesn't agree with the orthopedic jumping the gun. I even asked the orthopedic on the phone if this could be a generalized edema and he said you wouldn't get pain with that... I go, "Remember I told you in the office, I had zero pain?" He forgot that!

So I think I am going to go with my family doctor and then go from there.

I just know I don't have one ounce of pain and like you said with your Sjogren's, you have pain and it's usually bilateral. I have nothing wrong with the other ankle and I have zero pain.. hmmm.

How high has your sed rate been with a flare up? What is the difference between sed rate and crp? If one is up, does that mean the other should be up, too?

Thanks so much for your help!

Last edited by ClevelandEuc; 06-27-2012 at 10:35 PM.

 
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Old 06-28-2012, 06:24 AM   #4
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Re: Can you have RA, have a swollen ankle but with zero pain?

Hello,
I am not a Dr of course, but want to share with you my own thoughts.
I have heart disease, so my ankles (one at the time or both sometimes) swell up big time. This is a symptom of my heart not working right, and fluid develops. No pain when this happens.
My hubby is diabetic with kidneys damage and when his kidneys don't work properly, fluid develops as well and his ankle may swell up either one or both and again - no pain at all.
I do have RA; when it flairs, joints swell - than i develop a lot of pain with it. This is RA related for sure. Ankles can swell from RA big time, but always both at same time and it very hot and painful.
Did you GP ever suggested to check your kidneys and your heart? Just ask him if this may be a good idea.
I read that from Lyme it can swell too; not sure about pain or not though. And in 99% blood doesn't show Lyme, usually good DRs diagnose this condition by symptoms only.

Good luck to you
Moldova

 
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Old 06-28-2012, 09:05 AM   #5
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Re: Can you have RA, have a swollen ankle but with zero pain?

I also would take photos of all the swelling etc-anything. I have a whole album-on my phone so by the time i get to see a dr and the swelling or rash is gone-i have a great disgusting pic to show them. Then they always say "oh" and change their diagnosis-it has helped alot! I'm not sure what my SED rate was, i just saw it was 5 times higher than the high # it should be. Thats when we started auto immune testing. But it took another 2 yrs before i had a test for Sjogrens-thats a completely diff auto immune test-wish i had been told that then. I'm not sure the diff between SED rate and CRP, maybe someone else can answer that. i know SED rate measures inflammation in the blood. But it was only positive during bad flare ups-so its not always consistent. Thats why i took my blood tests with me to all dr appts. I think u wrote u were tested for Lyme-if not that is a good idea. i've met alot of people who tested negative who had lyme-drs can miss that. And for some reaso they don't want to test for it. My dr tried to tell me there is no lyme in Utah??? and i had just met a woman in the waiting room who had recently had it?? Moldova may have something with the diabetes and heart? just keep looking and don't give up-you know whats normal for your own body! hang in there!

 
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Old 07-04-2012, 05:39 PM   #6
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Re: Can you have RA, have a swollen ankle but with zero pain?

Quote:
Originally Posted by ClevelandEuc View Post
What does everyone think?

This is where I'm at. I went to an orthopedic who said based on x ray it is not OA, and now is thinking it's rheumatic. However, he ran the following:

CBC = normal
RF = normal
ANA = normal
Sed Rate = normal
CRP = high normal at 8.2, but I've had 9.4 one year ago and my endo didn't think it was anything, and said he suspected it would come down, it did.
Lyme test = normal
Sjogrens tests = normal

My primary looked at my tests and believes it is something other than rheumatic disease because:

1) Tests are normal
2) I do not have ANY pain in the ankle, just diffuse swelling, zero pain.
3) She said it's usually bilateral or more joints would be involved usually.

I am seeing her in one week. The orthopedic refuses to even get an MRI. He wants to push me off to another specialist. I am just going to go with my primary and see what she thinks on exam and go from there.

Oh, I also had an ultrasound to rule out a blood clot and that was fine.

So I am wondering if this ankle could be RA even if I have zero pain? When I went for my ultrasound at the ER last Friday the ER doc thought it was a generalized edema in the ankle and thought possibly dietary or something like that. He never even mentioned inflammatory arthritis!

What does everyone think? Wouldn't I have pain in the ankle? Or more symptoms or something more off in the bloodwork?

 
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Old 07-04-2012, 05:53 PM   #7
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Re: Can you have RA, have a swollen ankle but with zero pain?

Sounds exactly how mine started 12 yrs ago. I had bypass surgery at 50 and thought the swelling in my ankle was caused by the vein that was removed so I didn't think anything of it other than telling my GP about it. I few years later I started limping slightly and I didn't even notice it, someone else did. I decided to go to an orthopaedic doc who thought I may have an a fracture caused by twisting my ankle as the xray did show inflammation. He gave me a brace to wear and had me come back in 2 mos. No improvement so was sent for PT over a 8 week period. Still had swollen ankle but seemed to be a bit better. Another few months go by and no improvement. The Ortho doc then sent me to Rheumatology and had all the tests that came back neg like yours. She felt I may have RA so put me on Methotrexate pills. Was on them for 3 mos and no results so took myself off it and went back to RA. She agreed that I did not have RA and sent me back to Ortho . Another few years, a few MRI's,Xrays and casts and still no improvement. By this time my ankle joint was getting very damaged and obvious to the eye. Now sent back to RA again and told while I don't test pos for RA there are many inflammatory arthritic conditions that I probably have one of so back on Methotrexate but this time injections. Been on it for 17 weeks and no results and if anything getting worse. Sounds like you have the starting of what I may have but stick with your RA and try to get the swelling under control so the ankle doesn't get damaged like mine is. Right now I need to find a medication that removes the inflammation and then go for a second opinion on how to fix my really bad ankle. I am hoping I don't have to have a fusion done. Be proactive until they get the swelling under control!

 
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