RELATED: 8 Things I Didn’t Know About Rheumatoid Arthritis Until It Happened to Me Here are 10 things you should know about seronegative rheumatoid arthritis.
1. Doctors Rely on Symptoms to Diagnose Seronegative RA, Not Just the Results From Blood Tests
Since blood work doesn’t tell the whole story, your doctor will want to find out if you’re experiencing these key symptoms:
Inflammatory joint painMorning stiffness for more than an hour in your hands, knees, elbows, hips, feet, or anklesJoint swelling, tenderness or pain, and sometimes redness. Typically, RA affects distal joints symmetricallySymptoms that appear symmetrically across the body and in multiple jointsFatigue
X-rays can also help your doctor make a diagnosis by showing signs of erosions or other changes in your bones. “Rheumatoid factor clearly plays a role in how serious rheumatoid arthritis can be,” says John J. Cush, MD, a professor of internal medicine and rheumatology at UT Southwestern Medical Center in Dallas. A different blood test checks for ACPA, which may be more closely linked to the development of the disease than RF. A study published in the journal Autoimmunity Reviews in July 2016 found that ACPA antibodies represent an independent risk factor for developing RA. Having ACPA suggests there’s a genetic risk factor for the disease, but it’s not necessary for either antibody to be present in the blood for a diagnosis of seronegative RA. RELATED: 6 Things About Rheumatoid Arthritis That Are Difficult to Explain or Understand
3. Seronegative RA Has Become More Common in Recent Years
According to CreakyJoints, a support, education, advocacy, and research organization for people living with arthritis and rheumatic disease, the majority of rheumatoid arthritis patients are seropositive. But while you’re far less likely to be diagnosed with the seronegative type of the disease, those numbers are on the rise, according to a study published in the March 2020 issue of Annals of the Rheumatic Diseases. Between 1985 and 1994, only 12 out of 10,000 people with RA were seronegative. Between 2005 and 2014, that number crept up to 20 out of 10,000.
4. People With Seronegative RA Often Have Different Symptoms
The conventional wisdom is that seropositive patients have more severe symptoms, but recent studies suggest that the difference between the two forms of the disease may have more to do with the joints affected than with the severity of the RA symptoms. And a report published in June 2016 in BMC Musculoskeletal Disorders found that further research is needed to better understand the long-term outcomes of patients with seronegative RA. “My experience has been that while the symptoms are similar, seronegative patients are more difficult to treat,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and a medical adviser to CreakyJoints.
5. Seronegative RA Could Become Seropositive Down the Road
Your rheumatoid arthritis markers may change over time from negative to positive, since many people with seronegative rheumatoid arthritis begin to develop RF or ACPA antibodies. “It happens, but it’s not that common,” says Dr. Domingues. Dr. Cush says people with seronegative rheumatoid arthritis may start to develop RF or ACPA within the first two years of diagnosis. RELATED: Rheumatoid Arthritis Myths Debunked
6. Seronegative Rheumatoid Arthritis Doesn’t Need to Be Treated Differently From Seropositive
The treatment options available don’t really differ regardless of what form of the disease you have. “Whether you are diagnosed with negative or positive, be aggressive in treatment and stay ahead of the disease,” advises Cush. The purpose of treatment in either case is to lessen pain and slow or prevent progression. “Remission as early as possible is the goal,” he says. Standard drug therapy in early disease includes nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil or Motrin) or Celebrex (celecoxib) to help relieve symptoms, and a class of drugs known as disease-modifying antirheumatic drugs (DMARDs) that can help alter the course of the disease, says Domingues. DMARDs include methotrexate (Trexall, Rheumatrex, Otreup, Resuvo) and hydroxychloroquine (Plaquenil). More powerful drugs known as biologics can be prescribed for more severe cases.
7. Seronegative RA May Not Be the Correct Diagnosis
According to Cush and Domingues, a small percentage of people with the seronegative form of RA will do very well on therapy and go into remission, and others will experience severe disease and require medication. And still others will not respond to conventional treatment, which may be because they don’t have RA at all. Spondyloarthritis conditions, which often affect the spine, are sometimes mistaken for seronegative rheumatoid arthritis.
8. New Symptoms May Change the Diagnosis
Eventually, people with seronegative disease may be diagnosed with a different disease altogether, according to the Arthritis Foundation. If, say, a person diagnosed with seronegative RA develops a skin rash, her diagnosis might change to psoriatic arthritis. Other changes or new test results could lead to a new diagnosis of chronic gout or osteoarthritis. “The most important thing at the time you see a rheumatologist is determining whether you have inflammatory arthritis or mechanical arthritis, where there is less that can be done to treat it,” says Domingues.
9. There Is No Way to Predict the Future Severity of Seronegative RA
Forecasting how any disease may progress is extremely difficult. Whether you’re diagnosed with seronegative or seropositive, there are no set expectations of how either form of the disease will play out in an individual. “Which type you have isn’t all that important, since you treat them both the same way,” says Domingues. RELATED: 5 Warning Signs That Rheumatoid Arthritis Is Getting Worse
10. Seronegative RA Is Sometimes Linked to Having Higher Levels of Inflammation Than Seropositive
In a European study of 234 people who had both types of rheumatoid arthritis and had experienced symptoms for less than two years, those with seronegative RA showed higher levels of inflammation and more affected joints, according to research published in January 2017 in Annals of the Rheumatic Diseases.
