Jennifer Freeman, MD
Jennifer Freeman, MD

Doctor of Medicine (M.D.) in 2008 from UT Health San Antonio, Surgeon at TRACC Dallas

Sep 20, 2018 4 min read

Seropositive RA: What is Seropositive Rheumatoid Arthritis?

The diagnosis of rheumatoid arthritis (RA) divides into two overarching types: seropositive and seronegative. Seropositive is the most common diagnosis among RA patients. Being seropositive means that your blood tests show the presence of antibodies that are hypothesized to cause symptoms of RA.

Seropositive RA is thought to present a more strenuous and severe course of symptoms than seronegative patients. However, if you have seropositive RA, don’t lose all hope. This isn’t always the case. Current treatment options available for seropositive patients can allow RA sufferers to prevent progression of the disease and still enjoy their quality of life.

What is Seropositive RA?

Someone who is diagnosed as seropositive has blood that contains antibodies that can attack their bodies and lead to joint inflammation. This is what doctors suspect causes RA symptoms. The specific antibodies in the blood of seropositive patients are rheumatoid factor or anti-CCPs or both.

Though your blood test may indicate the presence of these antibodies, it may not necessarily result in a RA diagnosis. A specific set of other clinical symptoms must also manifest in order to make a proper diagnosis of RA.

Symptoms of Seropositive RA

In addition to positive blood test results, seropositive RA patients suffer from a distinct set of clinical symptoms for at least 6 weeks in a row. These symptoms include but are not limited to:

  • — Joint pain and swelling
  • — Multiple joints affected
  • — Symmetrical (both sides of the body) joint symptoms
  • — Morning stiffness lasting longer than 30 minutes regularly
  • — X-ray results indicating bone and cartilage deterioration
  • — Appearance of rheumatoid nodules

Besides the apparent signs of RA, doctors will also need to be aware of other symptoms that can be easily mistaken for other conditions. These symptoms hint at the level of overall inflammation going on in the body. These often include:

  • — Low-grade fever
  • — Chronic fatigue
  • — Chronic illness
  • — Depression

When all of these pieces are put together, it creates an overall picture of the correct diagnosis, seropositive RA.

How is Seropositive RA Diagnosed?

To diagnose a seropositive patient with RA, the patient must test positive for the presence of the rheumatoid factor and/or anti-CCPs antibodies. There is, however, a difference between the two. Anti-CCP testing is newer and more sensitive than rheumatoid factor testing. Anti-CCPs can also show up several years before a patient shows any signs of RA. This is as opposed to the rheumatoid factor tests, which usually tests positive within a year of developing symptoms.

Rheumatoid Factor & Anti-CCPs

Once a patient tests positive for anti-CCPs and/or rheumatoid factor, it doesn’t necessarily mean the patient has RA. Testing positive for rheumatoid factor has a 70-80 percent likelihood of being diagnosed with RA. This leaves a remaining 20-30 percent who test positive for rheumatoid factor but who aren’t diagnosed with RA. A positive result for anti-CCP is much more likely to result in a full RA diagnosis.

There are a number of different conditions that these antibodies can lead to. For example, a positive rheumatoid factor test result can indicate the patient has Hepatitis C. This is why testing positive for both rheumatoid factor and anti-CCPs leads to a much more certain diagnosis.

Reaching a Full Diagnosis

To reach a full diagnosis, the patient must also clearly exhibit the pattern of RA clinical symptoms as described above, in addition to the positive blood test results. X-ray results are also a helpful additive in diagnosing the disease. X-ray results that indicate patterns of bone erosion and cartilage deterioration allow doctors to bring together a complete diagnosis.

Other blood tests can also be performed such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which test for the amount of inflammation in the body. These are older forms of testing, but are still used as very reliable methods of diagnosing RA.

While seropositive results are typically a good indicator of RA, a full diagnosis is not generally made unless the clinical signs and symptoms are also prevalent in the patient.

Seropositive RA Prognosis

Once a patient has been diagnosed with seropositive RA, it becomes much more helpful in narrowing down treatment options. This is because generally, doctors find that seropositive RA patients present a more severe set of symptoms throughout the disease course when compared to seronegative patients, though there are many exceptions.

Additional complications such as rheumatoid nodules or vasculitis are more likely to occur in seropositive RA patients. Rheumatoid lung issues are also more common in seropositive patients.

Seropositive patients are also more likely to develop other conditions alongside their RA symptoms. For example, cardiovascular disease is also associated with seropositive RA.

Despite these typical outcomes, no diagnosis can accurately predict the precise prognosis for seropositive RA patients. There are simply too many other variables at play, and so the progression varies from patient to patient.

Seropositive RA Treatment

Like all forms of arthritis, treatment for seropositive RA is focused on controlling pain and preventing or limiting further joint damage. Treatment for seropositive RA can combine prescription and over-the-counter medications, physical and occupational therapy, home care, and even surgery.

Medications

There are several specific medications that help treat seropositive RA symptoms. The most specific type of medication is called a disease-modifying anti-rheumatic drug (DMARD). These drugs help slow down the progression of RA and help prevent further joint damage. Methotrexate is one of the most well-known DMARDs available.

Beyond the drugs designed especially for seropositive RA, patients may also take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Inflammation can also be controlled with steroid medications like prednisone.

Therapy

Therapists who specialize in working with RA patients help change daily habits to assist with reducing strain on joints. There are also custom devices and tools available for patients so that they can continue their daily activities while preventing further joint damage.

Home Care

Regular exercise is recommended for seropositive RA patients. It helps keep joints mobile and builds muscle strength. During flare-ups, alternating between hot and cold compresses can help manage local inflammation and pain. Maintaining a healthy diet is important so as to limit susceptibility to infections and illness.

Surgery

Sometimes, surgery may be necessary to correct severe damage done to joints. When joints become deformed, surgical procedures can help reduce pain and improve joint mobility. In some cases, complete replacement of joints may be recommended. Surgery is only pursued in certain cases due to the potential for complications.