If you suffer from pain, swelling, and limited
function in your joints, you need to see a rheumatologist. What happens when all your laboratory tests
are negative or "so called" normal? Some of you will get a diagnosis of seronegative
Rheumatoid arthritis. In this video, I will discuss the most important
aspects of a seronegative rheumatoid arthritis diagnosis and answer the following questions. What is Seronegative Rheumatoid arthritis? Can seronegative RA mimic other types of arthritis? Is seronegative RA more aggressive than seropositive
RA? Can seronegative RA become seropositive? and
Is the treatment different for seronegative RA? Hi, I’m Dr. Diana Girnita, a board-certified
rheumatologist and the Founder of Rheumatologist OnCall. Don’t forget to subscribe to receive notifications
for new videos. What is Seronegative Rheumatoid arthritis? I think it is essential to understand that
rheumatoid arthritis is the most common autoimmune disease that I, as a rheumatologist, see and
diagnose in my clinic. RA affects approximately 1.5 million people
in the US. Females are more affected than men. Before we make the diagnosis of RA, we pay
attention to the clinical picture. The classical pattern of RA involves pain
and swelling in the joints, especially the hands and feet, in a symmetric and bilateral
pattern. So, hands, feet, shoulders, knees, and ankles
are affected simultaneously. Morning stiffness is also characteristic and
usually lasts more than one h and is improved by movement. Then, to help with our diagnosis, we order
labs and Xrays. The laboratory tests that we commonly order
for patients where we suspect RA are Rheumatoid factor and Anti-CCP antibodies,
along with other labs that I will discuss in another lecture. Now, when researchers have looked at percentages
of patients with positive markers, they have found that only
60-80% have positive Rheumatoid factor 65% have anti-CCP antibodies
And About 20% of cases have none of these markers
positive. If those markers are positive, or only one
is positive in the patient's serum or blood, I diagnose patients with seropositive rheumatoid
arthritis. If those markers are negative, I will diagnose
patients with seronegative RA, meaning the patient's blood/ serum does not contain positive
RF and anti-CCP antibodies. To make things more complicated, none of these
markers make a diagnosis of rheumatoid arthritis. These markers should be used in conjunction
with the clinical picture, the time of the onset of the symptoms, and sometimes, elevated
markers of inflammation. Let's return to this concept of seronegative
rheumatoid arthritis. Can seronegative RA mimic other types of arthritis? The short answer is YES. A recent study published in 2021 proved that
many patients initially diagnosed with seronegative RA developed other forms of arthritis in the
next few years. From 9700 patients initially diagnosed with
seronegative RA, approximately 560 changed their diagnosis. Of these 560 patients, about 48% had Psoriatic
arthritis, 43% had axial spondyloarthropathy, and the rest had inflammatory bowel disease
arthritis. Some situations of Sjogren or Lupus patients
can present with signs and symptoms of seronegative rheumatoid arthritis, so I recommend obtaining
at least an ANA test in the initial battery of autoimmune testing. In 2019, another study also identified other
causes of seronegative RA like -polymyalgia rheumatica
-gout/ pseudogout -reactive arthritis
-paraneoplastic arthritis (related to cancer) -giant cell arteritis
-juvenile arthritis This is quite common in rheumatology, as autoimmune
diseases develop and evolve over a few years. I have diagnosed many patients with seronegative
Ra that eventually had PSA in my practice. To learn more about PSA, check my video about
the most common signs and symptoms of PsA. If you are a patient with psoriasis, even
many years ago, tell your doctor about that. If you are a patient that has a history of
Chrons or Ulcerative colitis, also mention these to your rheumatologist if you are not
asked. If you also have lower back pain, frequent
tendonitis like Achilles tendonitis, elbow tendonitis or even inflammatory disease of
your eyes, mention these as they could be signs of axial spondyloarthropathy or ankylosing
spondylitis. If you want to learn more about AS, watch
this video on my channel. Is seronegative RA more aggressive than seropositive
RA? There is an ongoing debate. The truth is that we still do not know. In seropositive RA patients, we know that
certain risk factors such as the presence of anti-CCP antibodies, are associated with
poor prognosis or more aggressive disease. However, early diagnosis, and aggressive treatment
in the early stages of the disease can potentially stop the inflammation and prevent further
damage of your joints. Being proactive and under the care of a specialist
physician will help you to manage the disease better. Can seronegative arthritis become seropositive? Yes, some patients can become positive in
time, although we are not sure at this time, what is the percentage of patients that will
become seropositive. Is routine testing recommended? Not really, but in certain situations, your
rheumatologist will decide to retest you to make sure you did not develop another type
of autoimmune disease. Is the treatment different for seronegative
RA? Once a diagnosis of seronegative RA is made,
your rheumatologist will discuss your therapy options. The treatment is not different from seropositive
rheumatoid arthritis, but it will need to be individualized to your medical situation. As a general rule, the RA treatment is done
in a step-wise approach, starting with the least aggressive medications such as nonsteroidal
antiinflammatory medications, and hydroxychloroquine, then advancing to other disease-modifying
antirheumatic drugs like leflunomide, methotrexate or sulfasalazine. More targeted therapy is indicated if those
drugs are ineffective or not tolerated. These medications are collectively named "biologics". If you want to learn more about biologics,
watch this video on my channel. Biologics is a general term for many medications
targeting molecules that produce inflammation in your body, like TNF-alpha, IL-6 or JAK
enzymes. For treatment recommendations, you should
discuss in depth your clinical situation with a rheumatologist that will be able to answer
specific questions. Now. Thank you for watching this video. I hope you better understand the seronegative
RA. If you're interested in learning more, like
the educational content of my videos, make sure to like, share, and subscribe to my channel
so that you will be notified about upcoming videos. Have a great day, and see you soon!
