In short
Seronegative means blood tests for rheumatoid factor and anti-CCP antibodies are negative. Seronegative rheumatoid arthritis is still rheumatoid arthritis and needs the same treatment. The term is also used for the spondyloarthritis group, including psoriatic arthritis and axial spondyloarthritis.
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What does seronegative mean?
“Sero” refers to blood serum. In arthritis, “seronegative” means blood tests for two antibodies, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP), are negative. “Seropositive” means one or both are present.
The term is used in two different ways, which causes confusion.
1. Seronegative rheumatoid arthritis
Some people have the typical pattern of rheumatoid arthritis, with swollen, painful joints in the hands and feet on both sides and long morning stiffness, but negative antibody tests. They still have rheumatoid arthritis.
- It’s diagnosed from the pattern of joint involvement, inflammation markers and sometimes ultrasound or other imaging.
- Diagnosis can take longer because the antibody tests don’t help.
- Treatment is the same as for seropositive RA: early treatment to calm the immune system, usually led by a rheumatologist.
Some people who start out seronegative later test positive, and occasionally the diagnosis changes to another type of inflammatory arthritis over time.
Sore joints slowing you down?
Talk it through with an Australian doctor online. No referral needed.
2. The seronegative spondyloarthropathies
This older term describes a family of inflammatory conditions that typically test negative for RF, now usually called spondyloarthritis. They share features such as back and sacroiliac joint inflammation, pain where tendons attach to bone, and links to the skin, gut and eyes:
- Psoriatic arthritis
- Axial spondyloarthritis, including ankylosing spondylitis
- Reactive arthritis, which follows some gut or sexually transmitted infections
- Arthritis linked to inflammatory bowel disease
Symptoms worth checking
- Swollen, warm joints
- Morning stiffness lasting more than an hour
- Back pain that’s worse in the morning and better with exercise, especially starting before 45
- Heel or other tendon pain
- Psoriasis, gut symptoms or red, painful eyes
When to see a GP
See a GP if you have swollen joints or inflammatory-type back pain, even if previous blood tests were normal. A GP can arrange tests and refer you to a rheumatologist.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-2038.
- Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81.
- Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73-84.
- Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med. 2017;376(10):957-970.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.