I don't think hormones on the radar of an awful lot of rheumatologists. I once mentioned it in passing to my doctor and she perked up and asked me a few questions about it. She said that a lot of her female patients experienced an increase in symptoms around PMS time, but as far as I could tell, she viewed it as an interesting factor in living with RA. There has been some research on it - I did some digging about it a while back and there is probably more than I found that the time. I guess research into the immune system is more likely to result in treatments that can be applied to everyone with RA. Still, you'd think it would be worth looking into.

Pain doesn't always equal inflammation. Basically, there are two kinds of pain with RA: pain that results from inflammation and pain that results from damage to the joint that has been caused by inflammation. The best way to describe it is that damage pain feels sharper, less soggy, less like something wrong is going on deep in the joint. Obviously, it still feels wrong, but in a different way - a friend of mine once described pain from active RA as like a butter knife is slowly being squeezed between the bones of the joints and wriggling a space into it. Pretty close to the mark in my experience.

If I were you, I'd get a second opinion. As far as I can tell, most rheumatologists - the good ones, anyway - don't rely too much on blood tests. I was at a forum about RA a couple of weeks ago with a keynote speech by Dr. Edward Keystone, one of Canada's prominent rheumatologists (I'll be posting about it in early January, including a link to the webcast). He said that if you have inflammation and swelling, a diagnosis of RA can be made even though your blood tests are normal. The question is whether you have any sort of swelling in your joints and if you do, even just a little, you can risk damage in the long run. When you see your rheumatologist, does he feel your joints? Do you have any joints that are tender if they're pressed? For instance, if you have RA in your fingers and you put the index finger and thumb on the other hand on each side of e.g., the middle joint in a finger and squeeze, it's not supposed to hurt. This was a huge surprise to me when I found out several years ago, because it always hurt with me. Now that I'm on Humira, it no longer hurts. This is where you need a good rheumatologist, because they'll be able to assess the level of "squishyness" in your joints, relying on examination more than they would blood tests. If your doctor is palpating your joints when you see him and basing his advice on medical examination, he may very well be a good rheumatologist. Still, a second opinion wouldn't hurt.