seronegative ra | Arthritis Information

does a negative RA factor on my blood test mean that my RA is perhaps milder than what it would be if my results would have come back positive? im serongative but im not to sure whether thats a good thing or it doesnt make any difference? x

I was diagnosed in March, 2004 with seronegative RA. My doctor (a very well respected rheumotologist) didn't hesitate to diagnose me based on what he could see. He told me that 2/10 patients he sees everyday are seronegative (25%). He describes my RA as aggressive and so far, resistant to treatment. Unfortunately seronegative does NOT mean a milder form of RA.

Sorry that you have to have RA at all. Stay close to these boards. They will help alot... in every way.

Take care

Barb

I always hate saying this....but I've been seronegative for 21 years (or at least I was up to 2003) and I believe I'm in the moderate-severe category. So sorry you're here because of RA but this is a good place for help.
wayney

If you do a PubMed search, there's lots of articles on the topic of seronegative RA. Some studies have shown that RF+ patients tended to have more severe erosions and a greater likelihood of having subcutaneous nodules. However, it looks like a lot of those studies were done in the 80s and some of the newer studies are looking at the HLA genetic marker as an indicator of disease severity. That marker is present in both RF+ and RF- patients and may be more predictive of joint damage than one's seronegative status. This would explain why many seronegative RA patients seem to be as bad off as the seropositive folks. But, in general, it doesn't seem like there's much consensus in the medical community regarding what factors are the best predictors of the course of this disease.

Some fun reading:

Rheumatol Int. 1983;3(1):47-8.

Related Articles, < =1.2> < =1.2> Links

A comparison of patients with seropositive and seronegative rheumatoid arthritis.

Edelman J, Russell AS.

It has recently been suggested that a subpopulation of patients with rheumatoid arthritis, diagnosed on clinical, radiologic and pragmatic grounds, but with negative rheumatoid factor tests, represents a clinical entity quite distinct from that of seropositive rheumatoid arthritis. We have studied 60 sequentially presenting patients, 30 of whom were selected because they were seronegative, and 30 selected because they were seropositive in regard to IGM rheumatoid factor. The only major differences detected between the two groups on "blind' assessment were a greater tendency to deformity, a greater degree of erosion and the presence of subcutaneous nodules in the seropositive group. Seronegative and seropositive rheumatoid arthritis appear to have very similar clinical features, but differing degrees of severity.

Destructive arthritis, rheumatoid factor, and HLA-DR4. Susceptibility versus severity, a case-control study.

Calin A, Elswood J, Klouda PT.

Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom.

In response to the continuing debate as to whether seronegative rheumatoid arthritis (RA) and seropositive RA are part of the same disease spectrum or are distinct disorders, we evaluated 720 patients with definite and classic RA, of whom 53 subjects had definite persistently seronegative destructive disease. For all but 1 seronegative RA patient, a seropositive RA case control was identified and matched for age, disease duration, degree of destruction on hand radiographs, and disease-modifying drug therapy. DR typing was undertaken on these 105 patients, together with scoring of hand radiographs. The frequency of DR4 was 69% in seropositive RA patients and 60% in seronegative RA patients (P = 0.22), versus 36% in 318 healthy controls (P = 0.008 and P = 0.007 versus seropositive and seronegative RA, respectively). Patients were matched and rematched with different controls in a series of subanalyses in order to make comparisons of hand radiograph scores. We found that HLA-DR4 was associated with destructive RA in both seropositive and seronegative RA patients. In general, DR4+ patients had more severe disease by radiologic criteria than did DR4- patients. Thus, HLA-DR4 may be an additive factor to the serologic status and may be more closely related to disease severity than to disease susceptibility.

PMID: 2487036 [PubMed - indexed for MEDLINE]

Another seronegative with aggressive RA for 24 yrs. If you have a positive RA factor that makes the diagnosis easy, for the rest of us it took longer time to get our diagnosis in most cases. You'll find lots of help at this board. Welcome.

Barb

but i have damage and from what i understand its pretty much the same just 'doesn't show up'

Good luck. You found a good place here though.

Add me to the negative list of folks here too....and mine is aggressive according to my doctors and the coarse of treatments I've been on over the years. I tend to agree with them...it is progressively getting worse despite the "aggressive treatments"; which is the norm for all of us.

Lovie38483.4101041667Im new here and reading alot of this information is very informative to me. I also have seronegative ra. It took 3 hospitals and 3 hospitals stays to finally diagnose me. First, hospital said i had MS. It finally took for me to be swollen from head to toe and not being able to walk one morning when i woke up and lucky for me the doctor on call was a rheumatologist. She knew exactly what I had. On top of that I also have fibromyalgia. What I am upset about is not being able to do a lot of the things I used to enjoy such as hiking. I walk too long and my knees hurt sooo bad. I have like zero energy. I work full time and by the time the weekend comes Im physically exhausted and end up spending the weekend laying around at home. The dr. just put me on enbrel so I hope that helps me out.
Nice to meet all of you. :)
i have been seronegative for 8 yrs. my lower spine is especially effected thank god for a good rheumy Karla, that is exactly how I feel. I went for a walk on Sunday and when I got back my knees where on fire and I promtly fell asleep for two hours. How frustrating. Work really does exhaust you for the weekend. Haven't been to the cinema for two months now as I can't sit in the same position for that long. I am still waiting for I diagnosis. My doctor thinks I have RA, the rheumatologist couldn't make his mind up and told me to come back in four months! I am also seronegative.Seronegative here too. I've always "wanted" a positive test just as some sort of confirmation. Isn't that odd?

OK, I have some questions. I just got off the phone with my RDs nurse. My RD called in sick today, so I couldn't speak with her, and probably won't be able to until next week.

My questions are: Does seronegative mean a normal rheumatoid factor, or does it mean all of your blood work is normal?

I called the RDs office this morning to get my lab results from two weeks ago. Here's what the nurse told me.

ALL of my lab results are normal, except the RF, which is only 21 (normal being 0-20). At 21, I'm calling it normal. Even my sed rate was within the normal range. I have visible swelling in my hands, knees, ankles, elbows, just about every joint possible. The RD even saw the swelling, so I know it's not my imagination. So how can I have swelling, yet have a normal sed rate?

The nurse told me that I'm symptomatic, and that I should continue to take the Enbrel (which I can't afford). Can fibro cause swelling? I have fibro too. The RD said that some of my pain was fibro, but some of it was definitely the RA. She also said the bumps that are growing on my fingers, etc., are from the RA. But what are they? My fingers, knees, and ankles are developing these ever-growing bumps at the joint. Not soft bumps, but very hard, like bone. Yet x-rays show no abnormalities. I'm so confused right now, and ready to cry. My family already thinks I'm making this whole thing up. When first diagnosed, all of my lab results showed abnormal. My sed rate was quite elevated, my RF was quite elevated, etc. And I'm worse now than when I was first diagnosed.

Can anyone help shed some light on all of this for me? I feel like I'm swimming in a pool of muck, and sinking fast.

Cris

Ok...I might be able to help you. From all I've heard and read, reading over my own charts as well....seronegative is just negative for RF. If you are taking Enbrel and your labs have changed.....it means it is doing it's job.

Fibro causes pain but not swelling. Or at least in all of my research I've not seen where it causes swelling...Others with fibro say different, they adamantly state they get swelling and that all they have is fibro.
The bumps ar a new one to me. I thought nodules were soft...but I also admit I know little about them as I don't get them. All that said....my labs are always normal. I've occasionally had an elevated SED but usually in conjunction with an concurrect infection which can also elevate sed.
hope this helps. also....check with enbrel.com to see if there is any help through wyeth-amherst for help on obtaining it.

hugs ,wayney

Chris

The bumps are probably nodules and are quite common with RA. This link explains more

http://arthritis.about.com/cs/nodules/a/rheumanodules.htm

Seronegative generally means that the bloods arent showing up RA factor, even though all the signs are pointing at RA. A lot of Researchers and Doctors do, unfortunetly, have a difference of opinion as to why this might be.

Sorry to hear your feeling this way, hope you feel better soon.

Thanks Wayney and Dagda. I've only taken Enbrel once so far. I just started it last weekend. As for the swelling, I've had two RDs tell me it can be from fibro, and two tell me that fibro doesn't cause swelling. None-the-less, it's there.

Thanks for the link on the nodules. I'll check it out. When I saw the RD two weeks ago, she said they weren't, but who knows. Do rheumatologists even know what they're talking about? There seems to be so many varying opinions on everything, depending on who you see. I had one tell me I didn't have RA at all, and another tell me that I did. My blood work was abnormal before, indicating RA. Now I have an RD that tells me I do have RA, even though the blood work is normal.

I've never gone by the RF before, since it can be positive when you don't have RA, and negative when you do. So I discount that. But the rest of my symptoms point to RA. Is there something else that I should be checking into?

I was so sure before. Now I just don't know. Just tired of it all.

Cris