When persistent pain, swelling, and reduced joint function affect your daily life, consulting a rheumatologist is essential. But what if all your laboratory tests return negative or within the normal range?
You most likely feel confused and discouraged. In this article, we will cover this scenario where patients have all the signs and symptoms of what it looks like Rheumatoid Arthritis with negative Rheumatoid Factor and will answer these questions.
- How is Rheumatoid Arthritis diagnosed?
- What is Rheumatoid Arthritis without Rheumatoid factor?
- Can Seronegative Rheumatoid Arthritis mimic other arthritis?
- How to treat Rheumatoid arthritis with negative Rheumatoid factor?
How is Rheumatoid Arthritis diagnosed?
Rheumatoid Arthritis, commonly abbreviated as RA, is one of the most common autoimmune diseases affecting millions worldwide, with a clear predominance in females compared to men.
The diagnosis of Rheumatoid Arthritis is based on
- Clinical signs like joint pain affecting hands, feet, shoulders, knees, ankles
- Pattern of Joints Involved: symmetric and bilateral (both hands, both feet, both knees)
- Morning Stiffness (prolonged, usually more than 1 hour)
- Blood tests (e.g., markers of inflammation, Rheumatoid Factor, anti-CCP)
- X-rays (hands or feet to look for changes)
What is Rheumatoid Arthritis with negative Rheumatoid factor?
Rheumatoid factor and anti-CCP antibodies are the most common laboratory tests ordered when Rheumatoid Arthritis is suspected. About 60-70% of patients will test positive for Rheumatoid factor (RF) test, while 30% test negative. Additionally, only 65% of patients with Rheumatoid Arthritis test positive for anti-CCP antibodies.
That leaves us with about 20% or more patients diagnosed with Rheumatoid arthritis without rheumatoid factor. RF and anti-CCP tests will be negative in these patients, making the diagnosis more challenging.
These cases are diagnosed as Seronegative Rheumatoid arthritis (as both serological/ blood markers, RF, and anti-CCP antibodies are negative).
Can Seronegative Rheumatoid Arthritis mimic other types of arthritis?
Some patients initially diagnosed with Rheumatoid Arthritis with negative Rheumatoid Factor or Seronegative can mimic other forms of arthritis.
One study in 2019, spanning over ten years, found that some patients with Seronegative Rheumatoid Arthritis were eventually diagnosed as
- Polymyalgia rheumatica
- Gout/ pseudogout
- Reactive arthritis
- Paraneoplastic arthritis (related to cancer)
- Giant cell arteritis
- Juvenile arthritis
In 2021, a study on 9700 Seronegative Rheumatoid arthritis showed that some of these patients will be diagnosed in time with other forms of arthritis. Thus, out of 560 patients diagnosed later with another type of arthritis,
- 48% had Psoriatic arthritis
- 43% had axial spondyloarthropathy
- The rest had inflammatory bowel disease arthritis.
Other studies found that some Seronegative Rheumatoid Arthritis patients developed lupus or Sjogren Syndrome. This is quite common in rheumatology, as autoimmune diseases evolve over many years, and the clinical picture can be quite challenging at the beginning of the disease.
How to treat Rheumatoid arthritis with negative Rheumatoid factor?
Once a diagnosis of Rheumatoid Arthritis without Rheumatoid Arthritis is made, your rheumatologist will discuss the options.
Treatment needs to be individualized to the patient’s clinical picture.
The initial treatment course typically involves using less potent medications like NSAIDs (e.g., ibuprofen, naproxen, meloxicam, celecoxib) to address inflammation. In cases where these prove ineffective, we may recommend more powerful drugs such as leflunomide, methotrexate, or sulfasalazine, also called DMARDs (disease-modifying antirheumatic drugs).
When DMARDs are not well tolerated or efficient, we step up therapy to a newer class of specialized medications called Biologics. These drugs specifically target molecules responsible for causing inflammation within the body (e.g., TNF-alpha or IL-6, JAK molecules). If you want to learn more about Biologics, you can watch a video on my YouTube channel.
Book Your Consultation Now
Diagnosing seronegative Rheumatoid Arthritis is many times challenging. It is very important to listen carefully to your signs and symptoms to be evaluated by an experienced rheumatologist. The answer is in the patient’s story, not blood tests. If the rheumatoid factor and anti-CCP antibodies are negative, but you continue to have signs of inflammatory arthritis, You can still be diagnosed with Rheumatoid Arthritis.
At Rheumatologist OnCall, we combine cutting-edge scientific approaches and holistic strategies like nutrition, physical therapy, and stress management to treat our patients effectively. Do not hesitate to contact us for a thorough evaluation of Seronegative Rheumatoid Arthritis.
