{"id":1824,"date":"2024-01-12T13:32:16","date_gmt":"2024-01-12T13:32:16","guid":{"rendered":"https:\/\/sites.manchester.ac.uk\/remora\/?page_id=1824"},"modified":"2026-02-11T10:45:55","modified_gmt":"2026-02-11T10:45:55","slug":"checking-your-tender-and-swollen-joints","status":"publish","type":"page","link":"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/checking-your-tender-and-swollen-joints\/","title":{"rendered":"Checking your tender and swollen joints"},"content":{"rendered":"<p>[et_pb_section bb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; fullwidth=&#8221;on&#8221; next_background_color=&#8221;#000000&#8243; global_module=&#8221;322&#8243;][et_pb_fullwidth_menu global_parent=&#8221;322&#8243; _builder_version=&#8221;3.0.106&#8243; menu_id=&#8221;7&#8243; submenu_direction=&#8221;downwards&#8221; fullwidth_menu=&#8221;off&#8221; background_layout=&#8221;dark&#8221; module_class=&#8221;main-navigation&#8221; \/][\/et_pb_section][et_pb_section bb_built=&#8221;1&#8243; fullwidth=&#8221;off&#8221; specialty=&#8221;off&#8221; transparent_background=&#8221;off&#8221; allow_player_pause=&#8221;off&#8221; inner_shadow=&#8221;off&#8221; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221; make_equal=&#8221;off&#8221; use_custom_gutter=&#8221;off&#8221; custom_padding=&#8221;||0px|&#8221; prev_background_color=&#8221;#ffffff&#8221; next_background_color=&#8221;#ffffff&#8221;][et_pb_row allow_player_pause=&#8221;off&#8221; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221; parallax_1=&#8221;off&#8221; parallax_method_1=&#8221;off&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221; use_custom_gutter=&#8221;off&#8221; make_equal=&#8221;off&#8221; custom_margin=&#8221;||0px|&#8221; custom_padding=&#8221;||0px|&#8221; module_class=&#8221;breadcrumbs-row&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221;][et_pb_column type=&#8221;4_4&#8243;][et_pb_text admin_label=&#8221;Breadcrumbs (do not remove)&#8221; background_layout=&#8221;light&#8221; text_orientation=&#8221;left&#8221; use_border_color=&#8221;off&#8221; border_color=&#8221;#ffffff&#8221; border_style=&#8221;solid&#8221; module_class=&#8221;breadcrumbs&#8221; custom_css_main_element=&#8221;border-bottom: 1px solid #ececed;&#8221; module_alignment=&#8221;left&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221;]<\/p>\n<span><span><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/\">REMORA project<\/a><\/span><\/span>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section bb_built=&#8221;1&#8243; fullwidth=&#8221;off&#8221; specialty=&#8221;on&#8221; transparent_background=&#8221;off&#8221; allow_player_pause=&#8221;off&#8221; inner_shadow=&#8221;off&#8221; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221; parallax_1=&#8221;off&#8221; parallax_method_1=&#8221;off&#8221; parallax_2=&#8221;off&#8221; parallax_method_2=&#8221;off&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221; make_equal=&#8221;off&#8221; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; prev_background_color=&#8221;#ffffff&#8221; next_background_color=&#8221;#1d1d1d&#8221;][et_pb_column type=&#8221;1_3&#8243;][et_pb_sidebar admin_label=&#8221;Left Nav Sidebar&#8221; area=&#8221;et_pb_widget_area_1&#8243; orientation=&#8221;left&#8221; remove_border=&#8221;on&#8221; background_layout=&#8221;light&#8221; module_id=&#8221;left-nav-menu&#8221; show_border=&#8221;off&#8221; \/][\/et_pb_column][et_pb_column type=&#8221;2_3&#8243; specialty_columns=&#8221;2&#8243;][et_pb_row_inner admin_label=&#8221;Row&#8221;][et_pb_column_inner type=&#8221;4_4&#8243; saved_specialty_column_type=&#8221;2_3&#8243;][et_pb_text admin_label=&#8221;Text: Title and jump links&#8221; _builder_version=&#8221;3.17.6&#8243;]<\/p>\n<h1>Checking your tender and swollen joints<\/h1>\n<p>Find answers to commonly asked questions about checking your own joints.<\/p>\n<p>If you have a question about self-examinations that isn\u2019t addressed below, please\u202f<a href=\"https:\/\/sites.manchester.ac.uk\/remora\/#contact\">contact us<\/a>.<\/p>\n<p style=\"padding-top: 1.25em\"><strong>On this page:<\/strong><\/p>\n<ul>\n<li><a href=\"#measured\">Why are tender and swollen joints measured?<\/a><\/li>\n<li><a href=\"#which-joints\">Which joints should I examine?<\/a><\/li>\n<li><a href=\"#das28\">What is DAS28?<\/a><\/li>\n<li><a href=\"#not-feet\">Why are feet not included in the DAS28 score?<\/a><\/li>\n<li><a href=\"#where-to-examine\">How do I know where to examine?<\/a><\/li>\n<li><a href=\"#swollen-joint\">What is a swollen joint?<\/a><\/li>\n<li><a href=\"#tender-joint\">What is a tender joint?<\/a><\/li>\n<li><a href=\"#press\">How hard should I press on my joint?<\/a><\/li>\n<li><a href=\"#palms\">Why do I get swollen palms?<\/a><\/li>\n<li><a href=\"#swelling\">Is it normal to get swelling in one shoulder or hand but not the other?<\/a><\/li>\n<li><a href=\"#nodules\">Do nodules stay forever?<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_divider _builder_version=&#8221;3.17.6&#8243; \/][et_pb_text admin_label=&#8221;Text: Checking your tender and swollen joints&#8221; _builder_version=&#8221;3.17.6&#8243;]<\/p>\n<h2 id=\"measured\">Why are tender and swollen joints measured?<\/h2>\n<p>Assessing the number of tender and swollen joints is really important to help healthcare professionals calculate your disease activity. This tells them how active your RA is, and guides treatment.<\/p>\n<p>Examining your own joints can be useful for your own understanding and to enable you to report to your health care professional.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"which-joints\">Which joints should I examine?<\/h2>\n<p>The 28 joints included in disease activity scores are the shoulders, elbows, wrists, knuckles, middle joints on the fingers, and the knees.<\/p>\n<p>It\u2019s not that the other joints aren\u2019t important, especially from a patient viewpoint. It\u2019s\u202fjust that they are not included in the measure.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"das28\">What is DAS28?<\/h2>\n<p>The most commonly used score in clinics is the DAS28 score. DAS stands for disease activity score, while the 28 relates to the number of joints examined.<\/p>\n<p>It is made up of four components including a tender joint count, a swollen joint count, a blood test measuring inflammation, and the patients\u2019 assessment of their health over the last week.<\/p>\n<p>Other disease activity scores such as the CDAI, or clinical disease activity score, do not include blood tests.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"not-feet\">Why are feet not included in the DAS28 score?<\/h2>\n<p>Research has found that the overall DAS28 score does not differ between using 28 joints and a greater number of joints, including the feet.<\/p>\n<p>This is why the feet are not included in the measure. The 28-joint count has since become the standard measure used to assess disease activity in people with arthritis, and in clinical trials.<\/p>\n<p>However, the feet are often affected in RA, and it is therefore really important that people with arthritis and their clinicians discuss and assess the feet, to make sure that inflammation, and other problems are addressed. If you have problems with your feet,\u202fplease raise them with your rheumatology team.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"where-to-examine\">How do I know where to examine?<\/h2>\n<p>When examining the joint, you need for feel for the joint line which is where the ends of the two bones meet \u2013 this is where you will be able to feel swelling, if there is any.<\/p>\n<p>The\u202f<a href=\"https:\/\/youtu.be\/SBSJKMYNOaw\">training video<\/a>\u202f(YouTube) goes through each joint, and explains where the joint line is and how the patient can find it.<\/p>\n<p>It will become easier to know whether you\u2019re in the right place with time. Feeling where the bones move will help you determine whether you are in the right place.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"swollen-joint\">What is a swollen joint?<\/h2>\n<p>Joints might appear swollen for lots of reasons. In RA, healthcare professionals are looking for joint swelling caused by inflamed joint lining. This makes the joints feel soft and squidgy, like a grape. It is really important that only those joints which feel soft and squidgy are counted as swollen. This kind of swelling can last a long time, or can come and go quite quickly.<\/p>\n<p>Joints can be swollen for other reasons apart from joint inflammation. Osteoarthritis is quite often present alongside RA. Osteoarthritic joints are very hard and bony, and don\u2019t tend to change quickly. Although it will look swollen and can be tender to touch, this swelling is caused by bone, so will feel hard and not squidgy. These hard bony swellings do not count as a swollen joint.<\/p>\n<p>There are other structures around the joints which might make you think they are swollen, when they are not. Swelling outside the joint can include pockets of fluid called bursitis. Bursitis does not count as a swollen joint.<\/p>\n<p>Some people have rheumatoid nodules which are knobbly swellings attached to the skin. Nodules do not count as swollen joints.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"tender-joint\">What is a tender joint?<\/h2>\n<p>Healthcare professionals use the word tender to describe joints that feel painful, or sore. Joints may be tender and swollen, just swollen, or just tender.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"press\">How hard should I press on my joint?<\/h2>\n<p>You need to press on the joint either until it hurts, or until your fingernails go white. If your joint is tender to touch you don\u2019t need to press any harder, but you will still need to feel for swelling.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"palms\">Why do I get swollen palms?<\/h2>\n<p>Swelling can occur in places other than the joints, including the palms and the back of the hands. This is important to pay attention to, but does not count as swelling in disease activity scores.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"swelling\">Is it normal to get swelling in one shoulder or hand but not the other?<\/h2>\n<p>Although RA is often described as being symmetrical, it is very common for different sides of the body to be affected differently.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<h2 id=\"nodules\">Do nodules stay forever?<\/h2>\n<p>Nodules often stay for a long time. Sometimes they respond to medical treatment and may shrink, or go away.<\/p>\n<p style=\"text-align: right\"><a href=\"#et-boc\">&lt; Back to top<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner admin_label=&#8221;Row&#8221; _builder_version=&#8221;3.17.6&#8243;][et_pb_column_inner type=&#8221;1_2&#8243; saved_specialty_column_type=&#8221;2_3&#8243;][et_pb_text admin_label=&#8221;Button: Previous page&#8221; _builder_version=&#8221;3.17.6&#8243;]<\/p>\n<p style=\"margin-bottom: -5em\"><a href='https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/what-happens-if-i-withdraw\/' class='small-button smallsilver'>&lt; Previous page<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][et_pb_column_inner type=&#8221;1_2&#8243; saved_specialty_column_type=&#8221;2_3&#8243;][et_pb_text admin_label=&#8221;Text button: Next page&#8221; _builder_version=&#8221;3.17.6&#8243;]<\/p>\n<p style=\"text-align: right\"><a href='https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/what-will-happen-after-the-trial\/' class='small-button smallsilver'>Next page &gt;<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][et_pb_row_inner admin_label=&#8221;Row&#8221;][et_pb_column_inner type=&#8221;4_4&#8243; saved_specialty_column_type=&#8221;2_3&#8243;][et_pb_divider _builder_version=&#8221;3.17.6&#8243; \/][et_pb_text admin_label=&#8221;Text: In the section&#8221; _builder_version=&#8221;3.17.6&#8243;]<\/p>\n<p><strong>In the <a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/\">Information for participants<\/a> section:<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/background-to-the-trial\/\">Background to the trial<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/the-remora-app\/\">The REMORA app<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/taking-part-in-the-trial\/\">Taking part in the trial<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/how-your-information-will-be-collected\/\">How your information will be collected<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/your-data-security\/\">Your data security<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/impacts-to-your-routine-care\/\">Impacts to your routine care<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/who-can-take-part-in-the-trial\/\">Who can take part in the trial?<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/benefits-and-risks\/\">Benefits and risks<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/what-happens-if-i-withdraw\/\">What happens if I withdraw?<\/a><\/li>\n<li>Checking your tender and swollen joints<\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/what-will-happen-after-the-trial\/\">What will happen after the trial?<\/a><\/li>\n<li><a href=\"https:\/\/sites.manchester.ac.uk\/remora\/information-for-participants\/about\/\">About REMORA<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column_inner][\/et_pb_row_inner][\/et_pb_column][\/et_pb_section][et_pb_section bb_built=&#8221;1&#8243; 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If you have a question about self-examinations that isn\u2019t addressed below, please\u202fcontact us. On this page: Why are tender and swollen joints measured? Which joints should I examine? What is DAS28? Why are feet not included in [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":0,"parent":1746,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_exactmetrics_skip_tracking":false,"footnotes":""},"class_list":["post-1824","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/pages\/1824","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/comments?post=1824"}],"version-history":[{"count":15,"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/pages\/1824\/revisions"}],"predecessor-version":[{"id":2198,"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/pages\/1824\/revisions\/2198"}],"up":[{"embeddable":true,"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/pages\/1746"}],"wp:attachment":[{"href":"https:\/\/sites.manchester.ac.uk\/remora\/wp-json\/wp\/v2\/media?parent=1824"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}