‘My Rheumie says my RA is controlled, but I still have pain’ What could be the cause? let’s solve the puzzle…part 2

Let us continue with our endeavor of solving the puzzle.

Many RAers do have swelling of joints off & on & most of the times, it is absent when they reach the Rheumie’s clinic. This (called palindromic complaints) suggests that RA activity is minimal but definitely not fully controlled. The best thing you can do to help your Rheumie is to take snaps of the swollen joints & show him at the time of your visit. He can never miss out on the RA activity & modify your DMARds accordingly.

Are you a pure vegetarian? One of the causes of persistent pain can be vitamin D/ B12 deficiency. This deficiency generally causes diffuse pain rather than the typical RA pain localized to the joints.

Are you hypothyroid? Have you ever checked your thyroid levels? One of the causes of persistent pain is hypothyroidism. This again would cause diffuse pain rather than the typical RA pain confined to joints. The pain related to these causes would definitely be different from the type of pain one would experience when the joints were swollen.

We still have big pieces of the jigsaw puzzle remaining namely Fibromyalgia. To err is human.. Even Rheumies can be wrong. Even we can miss out on the RA activity at times… We shall look into this soon..

10 Comments

  1. Hello,

    I agree with the point mentioned that an RA patient doesn’t have pain while active work, but it pains while relaxing, what can be the reason. Also, how can one say RA is controlled even when there is pain?

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    1. The pain related to RA is worse in the morning & after rest. During sleep/ rest, blood supply to the joint becomes sluggish & inflammatory chemicals accumulate in the joint. This leads to the pain as well as stiffness. Once there is movement, the blood supply increases, inflammatory chemicals are washed away by the blood. Hence the pain & stiffness improves.

      And yes, there can be pain even when RA is well controlled. RA need not be the cause of all pains. For example- osteoarthritis can cause persistent knee pain in a RAer even when RA is well controlled. Unless we analyse & pinpoint the exact cause of pain (RA or otherwise), we cannot achieve full relief. The recent blogposts are all dedicated to this mystery of pain despite controlled RA. Hope it helps many RAers who face this dilemma.

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  2. I totally agree with Kavita’s quote that “an RA patient doesn’t have pain while active work, but it pains while relaxing”.same thng is happening wid me frm last couple of weeks.jst having slight pain during weekends only..!!! hw it happens??

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  3. yes, i also agree with the pain while relaxing.
    the more i sleep the more pain i have to suffer.
    but sometimes little extra work from daily schedule causes swelling in ankles too.very confusing
    why some of the joints become stiff n so painful even after few minutes of immobility?
    n is constant fatigue also because of RA?

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    1. This is very classical of active RA. Stiffness after rest & swelling of the joints with that extra bit of work suggest active RA. If RA is controlled, there should be no reason why a joint should swell.
      If the pain is unrelated to RA, there would be pain but no swelling involving the joints.
      Active RA by itself causes fatigue. If you ref to my previous reply, the inflammatory chemicals generated in the joints (cytokines) are washed out by the blood. These chemicals circulate throughout the body & cause the fatigue.

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  4. well, u dint respond to my last reply……
    fine…may be u dint hv anything to say..
    can a person normal blood reports for inflammation still hv symptoms of RA?

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    1. Yes. A RAer may, at times, have normal reports despite inflammed joints. Hence a Clinician is always helped by the symptoms & the joint inflammation on examination in judging the RA activity.
      Reports are a guide, while examination & a patient’s history remains the most important pointer to RA activity.

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