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Seronegative rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisSeronegative rheumatoid arthritisSCE Rheumatology

A 44-year-old woman with early seronegative inflammatory arthritis has swollen MCPs and wrists for four months. Anti-CCP and RF are negative, ultrasound shows synovitis with power Doppler signal, and radiographs are normal. She is anxious because her serology is negative. What is the most appropriate explanation?

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Correct answer: E — Seronegative rheumatoid arthritis remains possible when persistent clinical synovitis is present

RA is a clinical diagnosis supported by investigations; negative RF and anti-CCP do not exclude it. Ultrasound power Doppler synovitis provides objective evidence of active inflammatory arthritis despite normal radiographs. Waiting for erosions would miss the window for early disease-modifying treatment.

Reference: NICE NG100; EULAR rheumatoid arthritis recommendations