Types of Rheumatoid Arthritis

The two main types of rheumatoid arthritis (RA) are seropositive and seronegative RA, with juvenile RA being another type that only affects children. While knowing your type won't change the treatment or prognosis for your RA in the long run, it can help to inform your journey with RA and guide expectations.

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation in the joints. It is a chronic disease that progresses and has the potential to seriously damage joints and affect various parts of the body. Every year, 41 of 100,000 people are diagnosed with this condition.

How Is RA diagnosed?

As part of the diagnosis process for RA, you will go through various blood tests, which will evaluate the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, and anti-cyclic citrullinated peptide (anti-CCP) antibodies. The presence or absence of anti-CCP determines which type of RA a person has.

Woman taking blood from another woman
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Seropositive RA

A seropositive RA diagnosis refers to a positive anti-CCP blood test, which indicates that these antibodies produced by the immune system are present in a person's bloodstream. This blood test is used to identify the antibodies in the blood that can cause disease by attacking the body's healthy cells, which results in inflammation.

Seropositive RA is overall very similar to seronegative, but has a blood test to confirm the diagnosis, and is considered to be the more progressive, severe group. This also comes with more joint damage, deformity, rheumatoid nodules, and development of vasculitis and lung issues.

RA symptoms are lifelong and can come and go. Even in this more progressive type, there are flares and breaks from the disease. Seropositive people will experience symptoms of joint pain, stiffness and swelling. Multiple joints will be involved, and they will be affected symmetrically.

Seronegative RA

Seronegative RA is less common, and people with this type of RA will experience the classic RA symptoms. While it is usually the case a seronegative person won't have as severe of symptoms, doctors tend to approach the disease seriously due to its unpredictability.

Seronegative patients don't have the anti-CCPs in the blood, and therefore meet fewer criteria for diagnosis. In an early 2000 study, 12 out of every 100,000 RA patients were seronegative, which increased to 20 per 100,000 years later.

While the presence of antibodies in the blood can help point to the cause of symptoms, it isn't needed for a diagnosis of seronegative RA. Doctors depend on other signs to come to a diagnosis of RA. Blood tests don't tell the whole story, so symptoms are considered. These symptoms include morning stiffness, joint stiffness, swelling and pain, and symmetrical, multiple joint involvement.

Like seropositive RA, system-wide symptoms are common as well, including fever, fatigue, and mental health involvement. Rheumatoid nodules, vasculitis, and lung issues are less likely to affect seronegative people.

Some say the joint involvement is the main difference between seropositive and seronegative patients, and it is not the level of severity after all.

Juvenile RA

Juvenile RA, often referred to as juvenile idiopathic arthritis (JIA), is a form of RA found only in children. It is typically found in children 16 and under. While pain is common in kids due to growing pains, it's important to identify the correct cause of pain, stiffness, and swelling to determine if it is a result of JIA.

Children with JIA may also have symptoms of fever, rash, and swollen lymph nodes. Once diagnosed with JIA, the goal is to control inflammation and pain to keep the child active and social. Treatments for JIA include medications, therapies, and in extreme situations, surgery may be warranted.

Autoimmune Comorbidities

Not only does RA have overlapping symptoms as other autoimmune diseases, RA patients often have multiple comorbidities. Studies suggest screening and evaluating patients with RA for the presence of other autoimmune diseases are warranted.

The most common autoimmune comorbidities include:

Thankfully, management of RA can result in a decrease in other autoimmune disease activity and overall improvement across diseases.

Conditions Often Confused with RA

Not only are comorbidities common in those with RA, there are many conditions that can be confused with RA due to similar symptoms. Some of these conditions are autoimmune, like RA, and some aren't.

Conditions most often confused for RA include:

It's possible to have a misdiagnosis before the more obvious, serious symptoms of RA arise. Studies show a lag in diagnosis from initial symptom onset for RA patients.

A Word From Verywell

Rheumatoid arthritis is a serious, lifelong disease, but with the right treatment, you can maintain good quality of life. Understanding the types of RA can better inform you of what to take note of and the tests to inquire your health care professional about. While it's easier to diagnose RA with the presence of antibodies, the RA diagnosis is still possible without it. Be your own advocate by keeping track of your own symptoms and flares.

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