Kimberley,
I have been in the same boat for almost 2 years now. My Rheumie has changed my meds. I started on Sulfasulazine and then went to Arava about 6 months later. I have been on Arava for about 9 months now,
He has the same thought pattern, if there is no swelling, then the RA isn't active or causing damage. I do suffer from pain and stiffness daily.
When I first saw him, he told me to come back when I had a real flare, I thought that was what I was having.
I swell on occassion, lasts a very short time and goes away pretty quickly.
This week, it started on Monday, I woke up with both hands swollen, the right more so than the left. It still hasn't gone away. It is weird in that I am not in as much pain as usual, or at least it isn't the same kind of pain. The fatigue has kicked my butt this week. It is work, home eat, and then sleep. I am averaging 10 hours a night, and my boss told me that I looked tired.
I hope it gets better for you and that someone can answer your question about the damage without the swelling. I am curious also.
Kim

As far as I know, you can still have inflammation causing damage even if it's not visible. There have been studies. And that's my case too. (I'll link if I can find it)

Ive swelled very little since the first 8 mo. Not much redness either. But lots of fatigue & pain. I fired my last rheumy for saying no visible evidence and therefore all in my head. In middle of a flare & pain was unbelievable.

Now I know I have damage. Xrays prove it. Stopping my meds for over a yr due to supposed remission was not a good thing. If you're on Pred that can cause your inflammation markers to be ok.

The new Vectra test might be good for you. It sees the current status of your disease. Expensive but might be worth it for your peace of mind.

Good luck.

yes, the Vectra DA test shows what you need to know, it is expensive but the doctor office should be able to get help for you for paying for it. This test also helps the doc see if your on the right med, at least it did mine. Good luck.

Kimberly, Sorry to hear you are in the same boat as a lot of us. My doc has been using the Vectra test as a gauge in deciding therapy. She too seems to feel that because the test results are not getting worse then the RA is "stable". trouble is I have pain every day, redness and swelling off/on.You are right about the fatigue, it's a killer. I asked if this is the best I can hope for, and she referred me to pain management. I took that as a yes. I already take low dose Pred because I cannot take NSAIDS. My docs doesnt like to jump to a different biologic right away. I am waiting for my MRI appt and pain mgmt appt. I hope the new year will be better for you and for all of us. Take care!

Hi Kimberly, doctors tend to disagree on certian RA issues, but there can be pain and RA changes going on even without the swelling and redness. It happens a lot. I sometimes cannot hardly move and have a lot of pain without swelling. Depending on what area of the body I am complaining about even though the doctor does not see visible swelling he may order an x-ray to see if the x-ray can pick up any changes that may be occurring. Hope you get some answers soon. Feel better.

Thanks everyone I currently take humira bi weekly and methotrexate and daily prednisone 5mg. I used to take remix aide but I could no longer afford it and it quit working as well now I have been having nearly a constant flare but no swelling that I can see. I need a new Dr. I believe.lol