Current Medical Issues (Jan 2021)
Classification criteria for seronegative rheumatoid arthritis based on rheumatologist's practice and experience
Abstract
Background: Diagnosis of seronegative rheumatoid arthritis (SNRA) remains difficult because chronic synovitis is nonspecific and is seen in a large number of diseases. Although the 2010 American college of Rheumatology (ACR)/European League Against Rheumatism criteria enable early detection of seropositive rheumatoid arthritis (RA), it is not much helpful in identifying seronegative patients. Objective: The objective of the study was to suggest classification criteria for SNRA. Methods: This was a questionnaire-based study. A validated questionnaire was sent to rheumatologists all over the country to collect data regarding the points which they consider for detecting SNRA. The data so collected were analyzed to identify priority given to each point. Weightage given to these points was used to suggest systematic criteria for classifying SNRA. Results: Total 50 rheumatologists participated in the survey. They reported using the presence of inflammatory polyarthritis (62%), elevated acute phase reactants (high erythrocyte sedimentation rate [ESR] - 86% and high C-reactive protein [CRP] - 78%), absence of spondyloarthropathy features (68%), absence of antibodies (rheumatoid factor [RF] – 82% and anticitrullinated protein antibodies [ACPA] – 74%), and chronic infections for detecting SNRA. Based on these results, chronic inflammatory polyarthritis or synovitis confirmed by ultrasonography or magnetic resonance imaging, raised ESR and/or raised CRP, and negative RF and negative RF and ACPA were identified as mandatory criteria, while the absence of SPA features including psoriasis, absence of clinical features of connective tissue diseases, negative Antinuclear antibodies (ANA) by Immunofluorescence assay (IFA), and absence of HCV, HBSAg, HIV, TB as well as leprosy (in endemic regions) were identified as supportive criteria. Conclusion: We propose classification criteria for SNRA. This needs further validation and could be used for studies and clinical practice in future.
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