Introduction
Rheumatoid arthritis (RA), according to some researchers, is a group of illnesses rather than a single illness. It may also represent a single illness with numerous underlying causes. There are two basic subgroups of adult RA, seropositive and seronegative, regardless of how it is ultimately characterized. Blood tests for seropositive RA reveal abnormally high amounts of antibodies known as anti-cyclic citrullinated peptides (anti-CCPs). These are particular RA markers that can appear up to a decade before symptoms emerge. Around 60 percent to 80 percent of individuals with RA also have anti-CCPs. Although this is debatable, seronegative RA patients do not, by definition, have these antibodies in their blood.
Rheumatoid factor (RF), an antibody, was originally used by doctors to check for seropositivity. Most people who have anti-CCPs also typically have RF, although this is also true of many other diseases, including infections. Because of this, anti-CCP testing is now the standard, though it is frequently combined with an RF test for increased accuracy.
What Are the Causes of Seronegative RA?
When the body's immune system unintentionally targets healthy tissue, an autoimmune disease can emerge. It targets the synovium, or joint lining, in RA. As a result, the cartilage is damaged, which causes pain and inflammation in the joints. Long-term effects include cartilage damage and possible bone deterioration. The precise cause of this is unclear. However, rheumatoid factor and anti-CCP antibodies are present in the blood of certain RA patients. The inflammatory process may be aided by these antibodies. One will be diagnosed with seropositive RA if they have RA plus antibodies. The same signs and inflammation are present in seronegative RA patients. Yet they lack these antibodies. Researchers are still looking at the causes and significance of this.
What Are the Risk Factors of Seronegative RA?
It seems that some individuals are more prone to developing an RA type. Both seropositive and seronegative RA have the same risk factors, which include:
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Familial history and genetic influences.
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Prior exposure to specific bacteria and viruses.
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Exposure to secondhand smoke or smoking.
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Exposure to certain chemicals and minerals, as well as air pollution.
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Sex, as women, make up about 70 percent of RA patients.
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Age, since it typically manifests between the ages of 40 and 60.
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Obesity.
According to some research, periodontal disease or any triggering event that affects the mouth or lungs may contribute to the onset of RA. The authors of a 2018 study emphasize that while the general risk factors for both types of RA are the same, particular genetic characteristics may cause various types of RA. According to research, those who have seronegative RA may also be more susceptible to high blood pressure.
How Does Seronegative RA Affect Symptoms?
Seronegative RA shares many of the same symptoms as seropositive RA. They consist of the following:
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Inflammation, redness, and discomfort in the joints.
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Stiffness, particularly in the elbows, hands, knees, ankles, and hips.
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Morning stiffness that persists for more than 30 minutes.
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Continuous inflammation.
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Symptoms that affect both sides of the body's joints.
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Fatigue.
These symptoms typically first appear in the hands and feet in the early stages of the condition. But eventually, they might start to impact other joints. Moreover, the symptoms may alter over time. It is unknown how RA seropositivity or seronegativeness affects the course and prognosis of RA symptoms. In a previous study from 2013, it was discovered that seronegative RA patients were more likely to experience partial remission than seropositive RA patients. Overall, seropositive RA patients were more likely to experience progression and a poor prognosis. In 2018, some studies discovered that individuals with seronegative RA frequently had the more aggressive disease when they were diagnosed. Imaging examinations, however, revealed they had damage resembling that of RA seropositive individuals.
How Is RA Identified?
There is not a single test that can diagnose RA. The diagnosis involves a joint examination, potentially with X-rays and blood testing. The patient will probably be referred to a rheumatologist if the doctor thinks they could have RA.
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Rheumatoid Factor: The rheumatoid factor (RF) test is one of the blood examinations that might support the diagnosis of RA. The immune system produces RF, a protein that binds a typical antibody that can inflame tissue in the body. Elevated RF levels occasionally coexist with infections like hepatitis C and parvovirus, as well as autoimmune diseases like RA and Sjogren's syndrome.
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CCP Antibody: Yet RF testing does not provide a conclusive diagnosis. High RF levels in the blood are possible in healthy individuals without autoimmune diseases, especially as they get older. The fact that persons with RA can have normal levels of RF only serves to exacerbate the problem. Some persons will test positive for an antibody against cyclic citrullinated peptides (CCP) that was just recently found. The more sensitive and specific CCP antibody, also known as anti-CCP, may manifest before RF.
How Does Seronegative Status Affect the Diagnosis?
It could be more difficult to diagnose RA when one is seronegative. If patients exhibit disease-related symptoms, but the blood tests do not reveal RF and anti-CCP antibodies, then the doctor will likely conduct a physical examination and advise patients to have X-rays to check for signs of joint injury and inflammation. The physician will look for the following RA signs:
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Stiffness or joint pain, particularly on the right and left sides.
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Swollen, warm, or reddened joints.
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Dry or red eyes.
Remember that similar symptoms might be caused by other diseases, which can make seronegative RA harder to identify. They include certain forms of arthritis, such as:
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Psoriatic arthritis, which also affects the skin, is a form of arthritis that results from 'wear and tear,' or osteoarthritis.
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Spine-related ankylosing spondylitis is a frequent problem.
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Several other illnesses may just result in edema and joint issues.
How Is Seronegative RA Treated?
Seronegative RA is treated similarly to seropositive RA. It will concentrate on symptom relief, delaying the progression of the condition and avoiding joint damage. Future consequences, such as cardiovascular disease, can be avoided by reducing overall inflammation levels and disease activity.
The Management of Symptoms:
Nonsteroidal anti-inflammatory medications (NSAIDs) and steroids are a few alternatives for treating the symptoms of seronegative and seropositive RA.
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NSAIDs help reduce inflammation and pain during flare-ups. They have no impact on how the illness develops, though.
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When symptoms are bad or when they affect a certain joint specifically, steroids can help control inflammation. However, as steroids might have negative side effects, they should not be used frequently.
Decreasing the Rate of Development:
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Biologic medications, sometimes referred to as disease-modifying antirheumatic medications (DMARDs), and targeted therapy are options for delaying the progression of the disorder; by altering how the immune system functions, DMARDs can aid in slowing the progression of RA. A DMARD includes Methotrexate, for instance. Tofacitinib, a type of targeted therapy, targets particular immune system cells.
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A doctor could suggest an alternative if one medication is ineffective. Pain alleviation is not provided by DMARDs. Yet, by preventing the inflammation that can gradually deteriorate joint tissue in RA patients, they can aid in symptom reduction and preserve joints. It may take some time for DMARDs to start working. In the meantime, the doctor may recommend corticosteroids or NSAIDs to treat pain and inflammation.
Surgery:
For those who have a severe joint injury, surgery may be a possibility. Surgery to replace a joint can improve a person's mobility and function, as well as their quality of life.
Diet:
RA symptoms may be controlled by a few diets. Before implementing any special diets, however, consumers should consult with their doctor.
Conclusion
All of the symptoms of RA are present in people with seronegative RA. Blood testing, however, will reveal that they do not have a rheumatoid factor or anti-CCP antibodies. Researchers are currently looking into why this occurs. Seronegative RA seems to have a similar prognosis to seropositive RA. Future blood tests occasionally reveal that rheumatoid factor has grown over time in a person's blood. The best course of action will be suggested by a doctor. However, symptom management can be aided by lifestyle changes like a healthy diet and regular exercise.
