Can you still have RA even if your blood work is normal?

jennybyc

Yes. While most people with RA will at least have a raised sedimentation rate and/or C-reactive protein(both of which are tests that show inflammation but not what kind..just general) you can have RA and not have a positive test for RA. Up to 25% of people who have RA test negative.

And there is a whole sub-set of inflammatory arthritis diseases called the "sero-negative" spondyloarthopathies....inflammatory arthritis with no blood work findings that affects the spine and other joints(depending on type). You can have clean blood work and still be very sick. But X-rays or an MRI will tell them as a cardinal symptom is arthritis of the sacro-iliac(SI) joints of the pelvis.

My doc knows I have some kind of inflammatory arthritis but I test negative for RA so for the insurance people, he calls it inflammatory polyarthritis. But to me, he says, you have RA until proven otherwise as I have the symptoms, just not the one positive test. Treatment is still the same.

So what does your doctor think you have? Osteoarthritis? Are you seeing a rheumatologist? We're here if you have questions.

Jenny

mompensfan

In January, my test results came back normal and my Rheumy stated I had inflammatory arthritis. In May, it was determined that I have psorasis (mild case) and that I have psoriatic arthritis. I never even heard of psoriatic arthritis until I did research on it. There are several types out there that will not show up in blood work.

mazvazmazvaz

Thanks.
Ok, I was tested for RA and gout and for general inflammation and all came back normal. When I rang up the surgery to ask about my results, I spoke to the receptionist on the phone who had the results and she said that they are all fine and that no further action was required. I didn't speak to my doctor. But surely the whole point of the blood test is to detect inflammation and if it comes back normal surely it means that you haven't got joint inflammation/arthritis?

jennybyc

No. Having nothing found in your blood work doesn not mean you don't have arthritis. It just means you don't have an arthritis that shows in the blood. X-rays are far more sensitive in picking up arthritis in the joints. If you are still hurting, ask about x-rays to determine if you have osteoarthritis or even a "sero-negative" type. That is far more important than blood work.'

good luck...................Jenny

mazvazmazvaz

Ah ok, thanks! It's just very weird that my doctor hasn't asked for further tests or anything like that...it just feels ridiculous that I have to do all the chasing!!

Lourdes706

JennyBYC is right. I have psoriatic arthritis of the spine and all my blood work was negative including ESR & CRP (tests for inflammation). However, a bone scan showed that I had sacroilitis (inflammation of both sides of sacrum.) That's what made the diagnosis. (And the pain was unbearable! I'm now on Arava with great results.)

EllaFL

I would agree that it is strange that your rheumy is not proceeding any further. I have seen two rheumatologists and both were convinced that I have RA even though all of my tests always come back negative--including sed rate which is supposed to indicate inflammation. Even one time when my left knee was swollen to the point of needing to be drained with a needle (!!) and getting a shot of cortisone in it, my blood work all came back negative and so did the sample of fluid from my knee. An MRI of the knee at that time simply showed joint effusion--no infection or anything else.

Further research I have done on my own regarding RA indicate that the blood tests are only one way of confirming a diagnosis of RA, and 20% of people who have RA do not ever show the rheumatoid factor. Every time I wonder if maybe there is something else going on, my doc points out that all of my symptoms are absolutely classic, stereotypical RA and that I have responded to RA immune suppressant drugs so really that is a correct diagnoisis. I have been being treated for RA for close to 5 years now.

Honest opinion? If I were you, I would consider finding yourself another rheumatologist for a second opinion...

Lourdes706

I was diagnosed with psoriatic arthritis in 1995. All my blood work was negative. They did a bone scan & that's when they found inflammation in the sacro-iliac joints. An x-ray didn't show anything. Now another doctor tells me I don't have this condition because there are no inflammatory changes seen on the x-rays done this year. But all the symptoms are typical of PsA and the only meds that help are plaquenil & Arava (typical meds for inflammatory arthritis.) What do you think?

hopalong_too

Lourdes, I also had a negative ESR and CRP. I had a nuclear bone scan done which said "Arthritis OR osteoarthritis in bilateral shoulders, bilateral elbows, bilateral wrists, bilateral hips, bilateral knees, bilateral ankles and 1st MTP joints". It also mentioned arthritis in the cervical and lumbar spine. No definite type of arthritis.....just that it was there. I thought at last I would be able to get someone to listen to me. I went to a Rheumatologist and she gave me a quick once over and said I had tendinitis of the hip. I later got hold of the clinical notes and she wrote that she spent the entire appointment convincing me that "I am not riddled with arthritis". I have not found a doctor yet that will take me seriously even with this bone scan because of the negative blood work and no outward sign of inflammation.

EllaFL

I'm not a doctor, but even doing research on the web, the main signs of rheumatoid arthritis are "bilateral" joint inflammation as you described, also lasting morning paid and stiffness and/or pain, swelling or stiffness that occurs after being sedentary--for example, if I take a nap on a Saturday, when I wake up my hands are typically swollen and sore. The test are just one way of confirming a diagnosis. I have obviously been blessed by finding the right docs. When I first went to the doctor about 5 years ago, I had 2 swollen and painful knees and I just thought I had done too much gardening or something! Was told I probably had RA on my first visit, but she tested me for RA, lupus and lime disease. Nothing has ever come back positive but my first rheumy and the second one I switched to have always confirmed the diagnosis and at times have had to convince me when I questioned it.

Personally, I think you need to keep looking until you find the right rheumatologist.

Moldova

I had to jump into this conversation, I can't not to share with you my own experience and I hope it will help you somewhat.

I was Dx with Juvenile RA when I was 12. I had some mild treatments and than moved from my Dr and never went for many years to see anyone.
In my 30th I started to develop symptoms which ruled my life. I went to see RA in this area... One after another - all 4 of them told me I am OK and I don't have RA and this is only Fibromyologa and OA so Celebrex is your medicine.

I went with it for about 10 years being tired to go from Dr to Dr and see their careless faces; I decided to quit spending my money on them.

After I had 2 major spinal fusions, became disabled and was sent to PM, my PM Dr told me that he wants me to see this wonderful RA Dr at *** in NYC.
After 2 hours evaluation, she told me that I just was Dx with severe, far gone RA and need to start medication right the way, otherwise damages in my body will continue.
Meanwhile my blood work came back normal. She wasn't surprise at all. She told me that this is not uncommon to have very symptomatic patient and blood work doesn't show anything and V.V.
It takes really good specialist, very knowledgeable one to Dx you with RA. Many of them afraid or just don't care to go further with testings, evaluations if your blood work came back normal. Done this, been there.

I am very blessed to have this wonderful DR. Not only that I was Dx with RA, but also with MS and Lupus. Now I am on medications, I am doing better.

I am very positive person, but I am very upset with other Doctors who I went for help. I am upset only because they did not take time, they did not have enough knowledge to Dx me on time. By the time I was Dx by my wonderful RA Dr, I have fluid in my lungs and enlarged lymph nodes; torn tendons, ruptures in ligaments and muscles. I continued working, using my body a lot not knowing that beside severe pain all over my body, I continue injuring myself in a gym and by daily strenuous work where to pick a pat of water could cause tears and ruptures of the muscles and ligaments.

I have an advice from the bottom of my heart for those who know something is wrong, who is in pain and Doctors who they go to see - completely ignore them and their issues: CHANGE YOUR DOCTOR.
Don't even hesitate to go and search for a good Doctor. One more advice: if I went to see new Doctor in same area, I did not tell new Dr about going somewhere else. The thing is: they know each other and don't want to controversy another opinion. Do not tell your new Dr that someone else couldn't find anything, b/c you will get another: I think nothing is wrong with you. I learned this in a hard way.

Best of luck to you!
Moldova

hopalong_too

Thanks so much for your response. It helps just to know that "someone" understands. The problem I have is that nothing "looks" inflammed. It just "feels" inflammed...and sore.....and stiff. My feet are swollen tonight. I have another appointment with the Rheumatologist next week. This is the same one that wrote the clinical note that she spent the last session "convincing me that I am not riddled with arthritis". I am seriously thinking that I should cancel because I know that I will just walk away from there frustrated again!! If I say I can't do something, I am just told, "Well then don't do that". I have started swimming because I thought it would be easier on my body. Problem is my shoulders are so sore with the front and back crawl and I don't want to be told not to swim as I already have been told not to use the treadmill!

I keep thinking I will give this doctor one more chance to "hear" me. Problem is I don't "look" sick and I can see that an opinion is formed the minute I walk through the door. I feel like a belittled child instead of the adult that I am and am at loss for words so it is my fault for the most part.

Is it possible for the bone scan to be wrong?? My body doesn't think so but the doctor has just totally brushed it off.

Thanks again for all of your support. Hoppy

Lourdes706

Dear Hopalong too,
I also agree with Moldova's answer. Don't waste your time & get more frustrated by going back to the same doctor. Go see someone else in another place & consider not telling them about your previous doctor although this may create problems with your insurance not paying for identical tests being done. An excellent book to read is "How doctors Think" by Jerome Groopman, MD. He gives examples of such doctors. Super book that every patient should read. * Disallowed website and related information removed by hb-mod, moderator *

Let us know what happens!

hopalong_too

Thank you! I had to laugh! I have already bought and read the book and that was what prompted me to obtain the clinical notes for my review!!! A great book!

Again thank you to all of you.