Seronegative rheumatoid arthritis produces symptoms similar to rheumatoid arthritis but without the rheumatoid factor in blood samples. It begins with immune responses and can progress to joint damage, nerve pain, and involvement of other body systems. Diagnosis is challenging, and treatment is based on symptoms and disease progression.
The autoimmune disease, seronegative rheumatoid arthritis, can produce the same symptoms as rheumatoid arthritis (RA), although blood samples typically do not show the rheumatoid factor (RF) commonly associated with the disease. Up to 20 percent of patients with this chronic inflammatory disease do not initially show RF, although some eventually become HIV positive, producing the factor as the disease progresses. Inflammation, pain, and joint damage usually occur in advanced cases, and other body systems may also be involved. Healthcare providers generally treat seronegative rheumatoid arthritis based on symptoms and disease progression.
Seronegative rheumatoid arthritis begins with cellular and humoral immune responses in the body. White blood cells in the bone marrow and thymus begin making antibodies. These white blood cells and the chemicals they produce invade body tissues, especially the joints. The first seronegative symptoms of rheumatoid arthritis usually occur months before joint involvement and generally include depression, fatigue, and malaise, which may be accompanied by a low-grade fever. After two to three months, patients experience inflammation, pain, and tenderness in one joint.
As the disease progresses, more joints in the extremities become involved. Morning stiffness and joint pain continue over a period of hours, a symptom that usually differentiates RA from other types of arthritis. Seronegative rheumatoid arthritis typically produces joint swelling and tenderness along with warmth and pain with movement. These symptoms occur because the autoimmune response causes inflammation of the tendons which can lead to cyst formation and eventual ruptures of the connective tissue. Usually within two years of onset, loss of connective tissue causes erosion and proliferation of bone cells, which results in joint deformities.
The swelling and inflammation commonly associated with seronegative rheumatoid arthritis might also compress sensitive nerve tissue, causing nerve pain. Patients may also experience symptoms related to muscle involvement. The autoimmune response can progress and eventually involve the heart and lung systems, causing inflammation, fluid accumulation, and tissue fibrosis. Some develop a condition known as Sjogren’s syndrome, in which white blood cells infiltrate the lacrimal, salivary, and exocrine glands, inhibiting the normal flow of body fluids.
Definitive diagnosis of seronegative rheumatoid arthritis often presents a challenge in the early stages. Not only do patients not show RF in blood samples, symptoms can come and go. Individuals may experience exacerbation of symptoms for 24-48 hours followed by complete resolution. Some people have a complete remission within six months of the initial symptoms. The development of the anti-cyclic citrullinated protein (anti-CPP) antibody blood test has helped identify the disease in some patients who do not typically produce RF.
Healthcare providers typically prescribe seronegative rheumatoid arthritis medications related to symptoms. Nonsteroidal anti-inflammatory and corticosteroid medications generally help reduce inflammation and swelling. If X-rays indicate narrowing of the joint space, doctors may give disease-modifying antirheumatoid drugs, also known as DMARDs, to reduce the risk of joint damage and deformity.
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