Everything Looks Normal

"Everything looks normal."

It is the sentence every chronic pain patient dreads most.

You are sitting on the exam table, exhausted, joints aching, brain fog making it hard to focus. You have waited three months for this appointment. You detailed your history, your pain, and your sleepless nights. The doctor scans a single piece of paper, looks up, and delivers the verdict:

"Your inflammation markers are low. Your ANA is negative. You're healthy."

But you don't feel healthy. You feel broken. And now, you also feel crazy.

At Whole Health Rheumatology, we hear this story every single day. And we are here to tell you: You are not crazy. You are just under-investigated.

The Limits of "Standard" Rheumatology Testing

In the traditional medical model, rheumatology is often reduced to a checklist. Doctors are trained to hunt for very specific "red flags" in your blood work—things like a positive Rheumatoid Factor or extremely high C-Reactive Protein.

If those red flags appear, you get a diagnosis. If they don't, you often get a dismissal.

The problem is that chronic illness is rarely black and white. Many conditions do not show up on a standard 10-minute blood panel, and normal test results do not mean you are healthy.

Seronegative Rheumatoid Arthritis means you have inflammatory arthritis without the typical antibodies. Studies show that approximately 20-30% of people with rheumatoid arthritis test negative for both rheumatoid factor and anti-CCP antibodies. These patients can still have active joint inflammation and erosive disease, but their diagnosis is often delayed because their initial blood work appears "normal."

Hypermobile Ehlers-Danlos Syndrome (hEDS) is a clinical diagnosis based on physical examination of your joints, skin, and medical history—not a blood test. There is no genetic test currently available for hEDS. Diagnosis requires assessment using specific criteria including joint hypermobility (measured by the Beighton Score), systemic manifestations of connective tissue disorder, and exclusion of other conditions. If your doctor only looks at lab results and never examines your joints, they will miss this diagnosis entirely.

Mast Cell Activation Syndrome (MCAS) requires documentation of episodic symptoms affecting at least two organ systems (such as skin flushing, gastrointestinal cramping, breathing difficulty, or cardiovascular symptoms like rapid heart rate), elevated mast cell mediators during an episode, and response to medications that block mast cell mediators. Standard allergy tests are often normal in MCAS patients.

Normal inflammatory markers do not rule out disease. Research shows that inflammatory markers like ESR and CRP are frequently normal even in active rheumatic disease. In one study of rheumatoid arthritis patients with knee pain, nearly half had clear evidence of inflammation on synovial biopsy despite having normal CRP levels. In systemic lupus erythematosus, CRP is often disproportionately low even during disease flares. Studies show that 7-20% of people with polymyalgia rheumatica have nearly normal ESR at diagnosis.

ANA testing has significant limitations. While ANA is highly sensitive for systemic lupus erythematosus (approximately 98% at a titer of 1:80), low-titer positive ANA results (1:40) are present in approximately 30% of healthy people and increase with age. A negative ANA does not rule out all autoimmune diseases—many conditions including seronegative rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis typically have negative ANA tests.

If your doctor is only looking at the paper and not at you, they are missing the diagnosis.

We Treat the Patient, Not the Paper

Dr. Pinkston operates differently. We believe that you are the primary data source.

If your labs say you are fine, but you cannot walk up the stairs without pain, the labs are incomplete—not you.

Our comprehensive evaluations allow us to go beyond the checklist. We look for the connections that standard testing misses:

Gut-immune connections: How is your digestive health affecting your immune system and contributing to systemic inflammation?

Mechanical pain from hypermobility: Are hypermobile joints causing chronic pain, instability, and soft tissue injury that mimics inflammatory arthritis?

Central sensitization: Is your nervous system stuck in a heightened pain state, amplifying normal sensations into severe pain? Central sensitization is a recognized medical condition involving real structural and neurochemical changes in the central nervous system that cause pain amplification even without ongoing tissue damage. It is the mechanism behind fibromyalgia, many cases of chronic widespread pain, and some presentations of Long COVID.

Comprehensive physical examination: We perform detailed musculoskeletal examinations including assessment for joint hypermobility, skin changes, and patterns of inflammation that cannot be detected by blood tests alone.

What to Do When You Hit a Wall

If you have been told your pain is "in your head" or "just stress," do not accept that as the final answer.

Trust your body. You live in it; they don't. Chronic pain and disability are real even when standard tests are normal.

Request a comprehensive physical exam. Ask specifically for a Beighton Score assessment if you suspect hypermobility. Request examination of your joints for swelling, tenderness, and range of motion abnormalities.

Understand test limitations. Normal inflammatory markers do not rule out inflammatory arthritis. Negative antibody tests do not rule out autoimmune disease. Many rheumatic conditions are diagnosed primarily by clinical examination and history, not blood work.

Find a partner, not just a prescriber. You need a rheumatologist who views themselves as a detective, willing to look beyond the first set of normal labs.

At Whole Health Rheumatology, we don't stop looking just because the first test came back negative. We dig until we find the root cause, and then we build a comprehensive plan—using lifestyle medicine, appropriate medications when needed, and evidence-based therapies—to help you reclaim your life

Ready to be heard? Schedule your comprehensive 60-minute evaluation with Dr. Pinkston today.