Seronegative Rheumatoid Arthritis Treatment in Delhi, India

Rheumatoid arthritis is a disorder of the joints and causes them to swell, pain, and stiffen. There are numerous types of rheumatoid arthritis (all are autoimmune disorders), including seronegative RA and seropositive RA.

The majority of people are diagnosed with seropositive rheumatoid arthritis. The type can be diagnosed with the help of lab testing for the substance called anti-cyclic citrullinated peptide (anti-CCP) antibodies or rheumatoid factor in the blood. People without these antibodies are diagnosed as seronegative. These patients may have other antibodies or none at all.

However, antibodies can develop at a later stage in life. If this occurs, doctors change their diagnosis to seropositive RA. 

Symptoms of Seronegative Rheumatoid Arthritis

Some common signs and symptoms of seronegative rheumatoid arthritis are:

• Joint pain
• Joint stiffness in the hands, knees, elbows, ankles, hips, and feet.
• Swelling and redness in joints.
• Morning stiffness
• Muscle fatigue
• Joints that are warm to the touch.
• Persistent inflammation
• Eye redness
• Eye dryness

Stages/Types of Seronegative Rheumatoid Arthritis

Seronegative rheumatoid arthritis is of four types:

• Ankylosing Spondylitis: The leading causes of ankylosing spondylitis are lower back pain and stiffness. In severe cases, the back stiffens. Other parts of the body that may be affected include the chest wall, heels, and hips. First, the hips are involved in children, followed by the knees and spine.

• Reactive Arthritis: There is acute pain in the sacroiliac joint, causing symptoms such as pain, swelling, and joint inflammation. Slight swelling in the fingers is often noticed. However, reactive arthritis causes weight loss, skin irritation, and fever.

• Psoriatic Arthritis: This is associated with skin issues known as psoriasis. There is also a thickening, yellow tinge around the fingernails and toenails, and joint troubles arise from large hip joints and sacroiliac joints.

• Enteropathic Arthritis: It is a type of arthritis that affects the spinal cord and involves inflammation of the intestinal wall. This type of arthritis typically concerns large joints, such as the knees, hips, ankles, and elbows. In children, arthritis may begin before the intestinal inflammation.

Related: Arthritis Treatment in Delhi, India

Causes of Seronegative Rheumatoid Arthritis

The exact cause of seronegative rheumatoid arthritis is unknown. However, some factors that may be responsible for it are:

• Age: above 44
• Genetic inheritance
• Oral infection
• Excessive smoking 
• Uncontrolled stress 

Diagnosis of Seronegative Rheumatoid Arthritis

Doctors diagnose rheumatoid arthritis by assessing the symptoms and recording medical history, followed by lab and imaging tests. Patients with seronegative arthritis commonly present with specific symptoms and test negative for RF and anti-CCP antibodies. Some lab tests that help diagnose seronegative rheumatoid arthritis are:

• Rheumatoid factor (RF) assay (negative in seronegative rheumatoid arthritis patients).
• HLA tissue typing.
• Uric acid, to rule out gout.
• Erythrocyte sedimentation rate (ESR).
• C-reactive protein (CRP) level.
• Lyme disease.
• Anti-cyclic citrullinated peptide (anti-CCP) assay.
• Anti−mutated citrullinated vimentin assays.
• Complete blood count (CBC).
• Antinuclear antibody assay (ANA).

Some of the imaging studies used to diagnose rheumatoid arthritis include:

• X-rays: X-rays of the hands, wrists, elbows, shoulders, knees, feet, hips, cervical spine and other joints as indicated are taken. When patients test negative for antibodies, X-rays may show bone and cartilage erosion and damage, which can aid in a seronegative RA diagnosis.
• Magnetic Resonance Imaging (MRI): Primarily, the cervical spine
• Ultrasound of Joints: Joints, tendon sheaths, changes and degree of vascularization of the synovial membrane, and erosions are evident on ultrasound imaging.
• Joint Aspiration and Analysis of Synovial Fluid: This may be indicated in some cases. 

Treatment for Seronegative Rheumatoid Arthritis

Treatment of seronegative rheumatoid arthritis aims to alleviate pain and discomfort associated with inflammation of the joints. Treatment can slow or cease the progression of the disease.

Seronegative RA causes severe damage to the joints and bones. This is because the body cells attack the synovial tissues that cushion the bones. When this tissue and supporting cartilage deteriorate, the bones rub against each other. This worsens the condition of the bones with time.

Medicines

Some forms of seronegative rheumatoid arthritis can be treated with NSAIDs. These drugs reduce inflammation and ameliorate the pain associated with joint swelling. In addition, these medications can increase the range of motion by reducing the swelling that leads to joint stiffness. Swelling also affects the range of motion of the joint.

Other medicines, like disease-modifying antirheumatic drugs (DMARDs), may slow the progression of joint damage caused by seronegative RA. 

Intra-articular Injections

Injections of hyaluronic acid, corticosteroids, BOTOX®, and platelet-rich plasma (PRP) given intra-articularly can effectively reduce inflammation, relieve pain and improve the function of the affected joints.

Herbal Remedies

Numerous herbal therapies relieve the symptoms of seronegative rheumatoid arthritis. They also help patients manage this disorder. Some supplements include fish oil, evening primrose, rosehips, frankincense, turmeric, probiotics, or glucosamine. This helps ease the affected joints and enhance the range of motion. However, before starting these, consulting with a rheumatologist is essential.

Therapy

Physical therapy can help patients regain mobility by teaching new methods of moving their bodies to complete daily activities. 

Healthy Lifestyle Habits

• Maintaining a healthy lifestyle can prevent seronegative rheumatoid arthritis from developing in the first place. 
• Regular exercise is necessary to keep the joints in motion and build the necessary strength to support proper mobility. In addition, exercise maintains a healthy weight, which reduces the chances of the development and progression of the disorder. 
• A nutrient-dense diet with whole grains, fruits, spices, and fatty acids can reduce or prevent inflammation and sustain a robust immune system.

Surgery

As the seronegative RA progresses, there is an increased risk of damage to the cartilage and joints. In such cases, reconstructive or joint replacement surgeries may be necessary to restore physical function and reduce pain. 

Complications of Seronegative Rheumatoid Arthritis

Some complications associated with seronegative rheumatoid arthritis include:

• Psoriasis
• Inflammatory bowel disease (IBD)
• Inflammatory eye diseases
• Occasional aortitis, mitral valve insufficiency (rare), heart block
• Restrictive lung disease
• Amyloidosis
• Urethritis
• Aphthous ulcer

Risk Factors of Seronegative Rheumatoid Arthritis

Numerous factors contributing to the development of seronegative rheumatoid arthritis include:

• Genetic inheritance.
• A family history of rheumatoid arthritis.
• Medical history of previous infections with viruses.
• Excessive smoking.
• Exposure to particular chemicals, air pollutants, and minerals.
• Sex: Seronegative rheumatoid arthritis shows a female predilection.
• Age: seronegative rheumatoid arthritis commonly affects people between the age group of 40 and 60.
• Obesity
• History of psoriatic arthritis.

Prognosis of Seronegative Rheumatoid Arthritis

The outlook for seronegative rheumatoid arthritis is better than that of seropositive rheumatoid arthritis. This may be suggestive of seronegative rheumatoid arthritis being a milder form of rheumatoid arthritis. However, for some people, the progression of the disease can be similar, and sometimes with time, the diagnosis can change to seropositive.

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