skip to main content

Seronegative RA Classification — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardAutoimmune SerologySeronegative RA ClassificationSCE Rheumatology

A 65-year-old man with seronegative RA (RF negative anti-CCP negative) has active polyarthritis of the MCPs and PIPs with raised inflammatory markers. Can seronegative RA still score ≥6 on the 2010 ACR/EULAR classification criteria?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Score seven points from joints, inflammation and symptom duration

The best answer is “Score seven points from joints, inflammation and symptom duration”. The 2010 ACR/EULAR RA classification criteria can classify seronegative RA. The joint involvement domain provides up to 5 points (≥10 small joints = 5 points). With serology scoring 0 (both RF and anti-CCP negative) and acute phase reactant scoring 1 (elevated ESR or CRP) and duration scoring 1 (≥6 weeks) the maximum achievable score without positive serology is 7 (5+0+1+1). This exceeds the ≥6 threshold. Approximately 20-30% of RA is seronegative. Seronegative RA may have a different genetic background (less associated with shared epitope) and different extra-articular manifestation profile. Ultrasound assessment of synovitis can support the diagnosis. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

Reference: 2010 ACR/EULAR classification criteria used alongside NICE UK rheumatoid assessment: https://ard.bmj.com/content/69/9/1580