Abstract
(1) Background: It has long been suggested that seronegative rheumatoid arthritis (RA) represents a clinical entity quite distinct from that of seropositive. However, analytical studies of seronegative RA dedicated to clinical outcomes regarding radiographic progression and related risk factors are scarce. The aim of this study is to evaluate radiographic outcome and prognostic factors for radiographic progression in patients with seronegative rheumatoid arthritis. (2) Methods: Subjects included RA patients reported as seronegative for both rheumatoid factor and anti-citrullinated protein antibody, who were treated at Jeju National University Hospital in South Korea between 2003 and 2016, including follow-up of at least 2 years. All patients fulfilled 1987 ACA or 2010 ACR/EULAR RA criteria. Radiographic progression was measured by yearly change in the Sharp van der Heijde (SvdH) score during follow-up periods. Medical records, laboratory and radiographic data were retrospectively analyzed, and linear regression analysis was performed to evaluate prognostic factors for radiographic progression in patients with seronegative rheumatoid arthritis. (3) Results: In total, 116 patients with seronegative RA were observed and 43 (37.1%) patients demonstrated radiographic damage during follow-up period. Mean age at diagnosis was 48 years and 86 (74.1%) patients were female. Symptom duration at diagnosis was 1.3 years and mean follow-up duration was 5.2 years. Patients with radiographic damage at diagnosis were 14 (12.1%) and mean SvdH score was 6.8 at diagnosis. Radiographic damage and SvdH at diagnosis significantly correlated with radiographic progression in patients with seronegative RA after adjusting age, sex, symptom duration, number of active synovitis, and CRP at diagnosis (β-coefficient 6.5 ± 1.84; p = 0.001 and β-coefficient 0.12 ± 0.02; p < 0.001, respectively). (4) Conclusions: This study determined that radiographic damage and SvdH at diagnosis were predictive factors in progression of radiographic damage in patients with seronegative rheumatoid arthritis. A large comparative study dedicated to this issue in seronegative RA is required.
Highlights
Rheumatoid arthritis (RA), which affects 0.4% of the general population, is a chronic autoimmune disease and results in joint damage [1]
Small joints (78.6%) were the most frequently involved in seronegative RA patients with radiographic damage at diagnosis
In the ARCTIC (Aiming for Remission in rheumatoid arthritis: a randomized trial examining the benefit of ultrasound in a Clinical TIght Control regimen) trial, included patients with RA classified according to the 2010 American College of Rheumatology criteria (ACR)/European League Against Rheumatism (EULAR) criteria determined that radiographic damage, disease activity measures, and remission rate were similar between patients with seronegative and seropositive rheumatoid arthritis [14]
Summary
Rheumatoid arthritis (RA), which affects 0.4% of the general population, is a chronic autoimmune disease and results in joint damage [1]. Based on serological status referring to the presence or absence of rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), RA is classified as seropositive or seronegative. RF and ACPA status are important factors for diagnosis, treatment decisions, and prognosis [3,4]. Incidence of seronegative RA is estimated in about 20% of RA patients [1,5]. Seronegative RA has been considered as a less severe clinical entity compared to seropositive RA, with less radiographic damage [6,7,8,9,10]. It has been recommended that patients with seronegative RA should be considered for less intensive treatment than those with seropositive RA, which is reflected in the 2015
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