Dr Ajesh Maharaj
Westville - Durban

FCP(SA) Cert in Rheumatology(SA)
Ph.D. (University of Amsterdam)

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Sero-Negative Arthritis

What is Sero-Negative Arthritis?

Sero-negative arthritis is used by doctors as an umbrella term for two different conditions: sero-negative rheumatoid arthritis and seronegative spondyloarthropathy. The term refers to inflammatory diseases, where there is inflammation and swelling, but the rheumatoid factor is absent. The presence of rheumatoid factor (during a blood test) is commonly used to diagnose rheumatoid arthritis (RA).

What is the Rheumatoid Factor?

The rheumatoid factor is a special type of antibody that is produced when your immune system is not working properly. Normally, when the body's immune (defence) system is healthy it will produce antibodies to protect the body. In various types of arthritis these antibodies can promote chronic inflammation of the joints and other tissues.

What is Sero-Negative Rheumatoid Arthritis?

About one third of people have the symptoms of RA where the rheumatoid factor is absent. People with sero-negative RA often have a less aggressive form of RA. It is thought that sero-negative RA may be caused in a different way to sero-positive RA (normal rheumatoid arthritis) although there needs to be further clinical trials to confirm this. However, sero-negative RA is treated in the same way as seropositive RA.

What are Sero-Negative Spondyloarthropathies?

Sero-negative spondyloarthropathies are a range of conditions where the rheumatoid factor is absent. The gene HLA B27 is present and the sacroiliac joint (which connects the bottom of the spine to the pelvis) and other joints where tendons attach to bones are often involved. Among these conditions are:

What are the symptoms of Sero-Negative Arthritis?

Common symptoms of sero-negative spondyloarthropathies are:

Children can also get sero-negative spondyloarthropathies. A distinguishing feature of juvenile spondyloarthropathies is the purple discolouration that occurs around a joint.

How is Sero-Negative Spondyloarthropathy treated?

People with a mild form of sero-negative spondyloarthropathy respond well to treatment with non-steroidal anti-inflammatories (NSAIDs), regular exercise and physiotherapy.

People with a more severe form of sero-negative spondyloarthropathy will be prescribed a combination of NSAIDs and drugs such as diseasemodifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulphasalazine and azathioprine. Some clinical trials are being carried out on the use of anti-TNFs on sero-negative spondyloarthropathies.

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