QD 77 - Don't Call Me Seronegative Save

Don't call me seronegative. This is Acuity Clinic brought to you by RheumNow live. I'm doctor Jack Cush from RheumNow, and our case today is called don't call me seronegative. A 42 year old guy comes to see me transferring his care from another city where he was diagnosed by a major university with a big name. Like this university a lot.

Don't know the doc there, but, you know, they're good enough to work there. They're good enough to work anywhere. Right. That's New York, New York. Anyway, and they diagnosed this gentleman with acute onset of polyarthritis in hands, knees, feet, whatever, as seronegative arthritis.

And then, he gets treated strangely with one round of nonsteroidals, and then he gets a TNF inhibitor that doesn't work, and then he gets another TNF inhibitor that does work. Never methotrexate, never prednisone, and he's had a little bit of back pain, but really not really. And so the next four years ensue. He's taken care of by three rheumatologists, and he's called seronegative arthritis, seronegative RA, and seronegative spondyloarthritis. What?

These are actually three divergently different conditions that aren't even close to each other, but the term gets thrown around not like manhole covers, but like nickels. I like that analogy. And I don't think we should be using the term at all. So let's be clear. There is no such thing ever again in this world as seronegative spondyloarthritis.

It's just spondyloarthritis or axial spondyloarthritis or nonradiographic axial spondyloarthritis or ankylosing spondylitis, but never is it seronegative. It's supposed to be knucklehead talking to me if I've ever used that term, and you if you've ever used that term. Spondyloarthritis is spondyloarthritis. There should never be another chapter written. And when when you do a search looking for as I did, I was writing chapters and pieces and lectures on seronegative RA, I could only find things written about seronegative arthritis, seronegative spondyloarthritis, and it's all talk talking about SPA related disease, not about RA and inflammatory arthritis, peripheral arthritis related disease.

So there is no more seronegative spondyloarthritis. Do not use that term. You can use seronegative RA because you diagnose rheumatoid, the tests come back positive, boom. It's one of the twenty percent, fifteen percent who are, in fact, seronegative for rheumatoid factor NCCP. We don't care about b 27.

That's talking about that other condition we just spoke about, spondyloarthritis. And then, you know, seronegative arthritis is like the most noncommittal, label and shame on any of us who use that. Call it what it is. Inflammatory arthritis, I don't know arthritis, wish it were arthritis, I hope it ain't arthritis, whatever, but don't call it something that doesn't say anything like seronegative arthritis. I'm not even sure your it really is arthritis when you call it that.

But it is important, I think, to maybe use the term seronegative RA. It's fifteen to twenty percent of patients. It actually denotes a condition that's severe, more severe than seropositive at the outset because you gotta have more criteria to be called RA because you can't have the seropositivity. And over time, they may respond as well. They may have less X-ray progression, and they may respond less well to at least rituximab and abetacept.

Seronegative RA is an important subset. It's just not a subset of RA. It's probably another disease. But, again, the big point of this whole schlameal is let's drop the seronegative spondyloarthritis term. It's so archaic, so confusing.

Three really good rheumatologists in the last four years have used it inappropriately in this patient who, by the way, doesn't have any of those conditions. Seems like it's a lot of arthralgia related to bad sleep, if you know what I mean. Anyway, that's it. Check out our rheumnow. Live site for more information on registration.

Tune in tomorrow for another QD clinic.