Current impact of seronegative rheumatoid arthritis
Authors:
Z. Hrnčíř
Authors‘ workplace:
II. interní gastroenterologická klinika LF UK a FN, Hradec Králové
Published in:
Čes. Revmatol., 28, 2020, No. 3, p. 152-159.
Category:
Review Article
Overview
Seronegative rheumatoid arthritis (SNRA) is defined as rheumatoid factor (RF) negative and antibodies to citrullinated peptide antigen (ACPA) negative disease. Seropozitive rheumatoid arthritis (SPRA) is defined as RF and/or ACPA positive disease, but also other Abs as valid biomarkers should be used. SNRA pts represent about 20% of RA in general population, largely on late-onset. Minor prevalence of SNRA is not predictive for minor difficulties in clinical practice. Comparative analysis of DMARD (disease modyfying anti-rheumatic drugs) naive SNRA and SPRA pts demonstrated significantly higher values of disease activity using DAS28/ESR (disease activity score/erythrocyte sedimentation rate), incl. 28TJC (tender joint count) and 28SJC (swollen joint count) parameters, and good response to csDMARD (conventional synthetic DMARD) therapy within 2 years follow-up study. Unfortunately, initial activity of SNRA disease is not predictive for easy diagnosis of early SNRA, because exclusion from other possible causes of early seronegative arthritis should be difficult or even actually impossible. In a 10 years. prospective observation study of pts classified as early SNRA (No:435) a reclassification to definite diagnosis was frequent, espec. in relation to polymyalgia rheumatica, psoriatic arthritis, osteoarthritis and gout, but also in a large number of rare conditions (Jaccoud’s arthropathy in systemic lupus erythematosus, ect.) and „orphan“ diseases with mimicry of SNRA. In a long-term 30 years follow up study was demonstrated a significant increased frequency of extra-articular manifestations in SPRA as in SNRA pts, but in SNRA with low risk of rheumatoid pulmonary fibrosis, peripheral/central neuropathy and systemic rheumatoid granulomatosis. Concomitant fibromyalgia, toxicity of long-term DMARD therapy and multimorbidity of SNRA pts should be always evaluated. Early positive identification of SNRA by means of novel perspective biomarkers (antibodies to progranulin, sulphate glycans, ect.) should be a hope for future.
Keywords:
seronegative rheumatoid arthritis – rheumatoid factors – antibodies to citrullinated peptide antigen – antibodies to progranulin – sulphated glycans – score DAS28/ESR – misdiagnosis – concomitant fibromyalgia
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Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
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