Wednesday, 22 May 2019

You are here

The Diverse Fate of Seronegative Rheumatoid Arthritis

A Finnish Rheumatology Center followed 435 early, seronegative rheumatoid arthritis (RA) patients for 10-years and found that only 3% became erosive or seropositive RA. They also found that 32% could not be further reclassified, and that the remaining 65% evolve into another diagnosis, led by polymyalgia rheumatica (16%), psoriatic arthritis (11%), spondyloarthritis (9%), and osteoarthritis (10%).  

Between 1997-2005  they enrolled 1030 patients into the early RA clinic at the Jyväskylä Rheumatology Centre. They included 435 seronegative cases (42%), of whom 69% were women, and prospectively followed patients for a ten-year period.

Among the 435 seronegative cases, the 10-year outcomes revealed:

  • 13 (3%) could be reclassified as seropositive or erosive RA
  • 68 (16%) cases of polymyalgia rheumatica
  • 46 (11%) psoriatic arthritis
  • 47 (10.8%) seronegative spondyloarthritis 
  • 45 (10%) osteoarthritis
  • 38 (8.7%) spondyloarthritis
  • 15 (3.4%) plausible reactive arthritis
  • 10 (2.3%) gout
  • 17 (3.9%) pseudogout
  • 6 (1.4%) paraneoplastic arthritis
  • 6 (1.4%) juvenile arthritis
  • 2 (0.5%) haemochromatosis
  • 3 (0.7%) ankylosing spondylitis
  • 2 (0.5%) giant cell arteritis
  • 8 miscellaneous diagnoses.
  • 41 (9.4%) had transient arthritis
  • 49 (11.2%) remained were not reclassifed.

After an initial diagnosis of seronegativity, prolonged follow-up revealed significant heterogeneity and reclassification of the inital diagnosis. Therefore seronegative arthritis should not be considered as a homogenous entity.

(Editor's note: This is a very interesting study. I'm amazed that only 14% kept a diagnosis of RA, but this may be a regional issue. While many Scandinavian cohorts such as these may have more seronegative spondyloarthritis patients manifesting as polyarthritis, the diversity of other subsequent diagnoses is interesting, if not humbling. One thing said by Dr. Ronan Kavanaugh on RheumNow some time ago was that "In seronegative patients in remission for years always consider withdrawing DMARD". I would add to that by saying you should always consider alternative diagnoses the longer you call someone "seronegative" RA.)

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Opioids, SSRIs and Steroids Increase Fracture Risk in RA

Analysis of a large US observational rheumatoid arthritis (RA) patients finds that opioids, SSRIs and glucocorticoids were associated with increased risk of fracture in RA, whereas statins and TNFi had a decreased vertebral fracture risk.

Denosumab Protects Against RA Erosions

Combining denosumab (Prolia) with a conventional disease-modifying antirheumatic drug (DMARD) such as methotrexate showed promise for slowing radiographic damage in rheumatoid arthritis (RA), a manufacturer-sponsored phase III trial called DESIRABLE found.

New ACR/AF Guidelines on JIA Polyarthritis and Uveitis

The American College of Rheumatology (ACR) and the Arthritis Foundation (AF) have released two guidelines on management of juvenile idiopathic arthritis (JIA). The first addresses the treatement of non-systemic polyarthritis, sacroilitis and enthesitis; and the second focuses on JIA associated uveitis - screening, monitoring and treatment.

Shorter Treatment Succeeds in Septic Arthritis

Two weeks of antibiotic therapy was as effective as 4 weeks for septic arthritis, a prospective single-center study found.

Among 77 patients randomized to a 4-week course of therapy following surgical drainage for native joint bacterial arthritis, the rate of complete microbiological remission after at least 2 months of follow-up was 97%, according to Ilker Uçkay, MD, of Uniklinik Balgrist in Zurich, Switzerland, and colleagues.

Targeting GM-CSF Works in Rheumatoid Arthritis

Namilumab, a monoclonal antibody that targets the granulocyte-macrophage colony-stimulating factor (GM-CSF) ligand, showed promise as a treatment for rheumatoid arthritis (RA) in a phase II study.