Not necessarily.

And conversely, you could have damage occurring without pain and inflammation.

Now don't you wish I hadn't answered?

Then how would you know if your medication is working?

@Californiadream LOL!!! But that's RA for ya!!!

@Millcomp - your Rheumys exam of your joints will be one way if he/she sees anything then maybe an X-ray, after that if there's still suspicion maybe an MRI

It's funny I had the exact same question. I have zero swelling, red joints and very mild inflammation or pain a few days a month. I pretty much chalk it up to that there is some damage even minuscule especially over time.

Exactly! That won't help my argument against biologics. Don't know if mtx working or not if still have minor swelling and pain.

How long have you been on mthx? It does take 6-8 weeks to work. As for me, I have mega damage from even minor pain and inflammation. Plus, as CADrea says, you can have damage with no obvious inflammation, like when you are on prednisone. Because prednisone just covers up the symptoms and does not deal with the disease and the damage.

My meds aren't working till I have no flares! LOL But seriously, that is my goal. I've had more or less no flares in my big joints, with Orencia/Arava/mthx. But my hands and wrists have small flares, and the finger are deforming at an alarming rate over the last year. I have all kinds of finger and wrist splints, but I am losing my ability to play flute the fingers are twisting so badly. Another reason I want a different biologic.

I was on mthx for 5 years and taking NSAIDs and prednisone. I was always in pain, and I have some terrible deformities in my feet and hands from that time. Especially the thumbs. So, basically, mthx did help, but not enough! When I added the biologic, I was at 100% most of the time for 5 wonderful years. That ruined me! I want that back!

Anyway, I do hope the mthx starts working, and do try a biologic or two if it does not stop the damage. Pain is bad but deformities are worse. I also have fibromyalgia, but I always downplayed the pain because it is not as bad as RA, and it doesn't cause damage. But I tried to cut back on Gabapentin, and I thought I was dying in the night. That was the end of that. Sometimes, the pain is bad, and you just have to bite the bullet and take all the drugs!

I don't want to start biologics any sooner than necessary. Everything I'm reading here makes me want to prolong the process because no one thing seems to work forever and I don't want to run out of options.

5 wks

I have mild and "atypical" symptoms (according to my rheum) and am seronegative. Since my joint symptoms were not responding to meds, and there is a question of whether or not I have RA at all...I recently stopped all my meds as a test to see if my joint pain changes or not. But that's another story.

My priority is prevention - Some people with mild disease (or those who are seronegative) do progress to severe disease, joint damage, and deformities. That is why I very enthusiastically agreed to start meds when my symptoms started.

@doodle-I'd love to hear that "no med" story. Sounds like something I'd try

For me, if a biologic works for a year, 6 months or 5 years, it means I am not in constant pain, but even more important, the deformities are more or less stopped. I am sero-negative too, but that means that the hands and feet are hit hardest, and last to respond. My feet are damaged beyond repair. I don't walk much, although I can ride a bicycle if I ride on my heels, or instep, because the forefoot is so damaged.

My hands are really getting bad. The thing about medications, is that if you hit this disease hard in the beginning, it is less likely to become severe. Back when I first got RA and was finally diagnosed after 2 long years of agony, because all my blood tests were negative, but I had flares in 100 joints and was in a wheelchair, I was treated mildly. Now, according to my rheumatologist, I have the worst case of RA he has ever seen.

That is what not taking the meds does to you. The thing is, you can try a biologic, and it is not going to kill you, ,even if you do react. You will have stopped the disease when you need to. But if you hold off and wait, the disease will enfurl like a monster, and then there will be no way to control it. And if the meds fail, well, at least you had a few good years! I had 9 mostly great years, I did many things including getting a Master's degree, getting my body in the best shape since I was a young person, and generally being happy.

Never settle for less! The biologics have all these stupid warnings about side effects that sound scary. But most people get none of them! And they are foregoing the chance to live relatively pain free and not have the terrible joint damage that I do.

I know I am strong about this, but no meds should never be an option. If the mild meds control the disease, well, lucky for you! I know a few people like that. But I also know a lot more people who either were not correctly diagnosed who are now like me, an ultra severe disease with terrible deformities.

I wish I could post a picture of my cousin. She got JRA when she was 1 1/2. They only had prednisone in those days, and it had never been tested on children or in the lab with young rats. Turns out, the side effects were terrible. Her growth was stunted - she is about the height of a 5 year old. Her bones are webs, because the prednisone drained her bones of calcium, so they will not give her any more joint replacements. Before she got bad, she had 2 sets of hips replacements and 2 sets of knee replacements, and constant surgeries because the muscles were twisting her bones. She cannot straighten her elbows. Mass muscle wasting of her upper body. She has lost the use of her hands, the deformities are so incredibly bad. She has to have someone do everything for her from dressing to feeding to driving and everything. She was on gold for years,, but then it stopped being effective. When she got an RA nodule in her throat, and literally died in the ER, they revived her with a permanent trache in her throat. I suggested she go on mthx, and her rheumatologist said "I never thought of that." I guess she thought she was too "mild" to need any drugs that actually stop the disease. Sure enough, she is doing a lot better on it. Did I mention she is completely addicted to prednisone, her adrenal gland has not worked in over 50 years? I do wish I could scare everyone into taking biologics, before they have ruined their body!

I absolutely agree 100000% that "no meds" should never be an option.

The reality is that you have no idea if the damage is occurring even if you feel fine.

Yeah, I know. Acceptance.

Look at it this way.......if you were diagnosed with cancer you wouldn't think twice.....you'd jump right into chemo.

RA is a serious disease, too, you know.

I'd have to agree even though I'm presently on "no meds" since December 2015 I experience light pain every once in a while & I'd rather be back to where I was before on MTX even at the lowest dosage I was about 99% pain, stiffness free. Now I feel like I'm around 90% pain/stiffness free. yeah that's still high but like many of you said if you beat the disease down far enough for a long enough period of time maybe when I'm in the late 50's, 60's or 70's the deformities will be down to a minimum?

I would like to add that I had this exact question come up on my last Rheumy visit & my Rheumy stated, "Damage occurs when there is noticeable swelling & inflammation". I didn't really go into it any further but the next time I will get more specific & ask, "Does damage happen regardless of any pain, swelling & inflammation OR ONLY when there's the above mentioned"??