Negative rheumatoid factor and 'clear' MRI scan

Good morning all.

After several weeks of very painful joints (neck, shoulders, thighs, knees, etc), I went to my GP.

He suspected RD and did bloods. They came back with a negative rheumatoid factor but did show high levels of inflammation. I was then refered to a rheumatoid specialist and an MRI scan which came back fine with no signs of inflammation.

I know I am in agony with the pain in my joints so know something is wrong but Im wondering if my bloods came back clear and my MRI scan is clear can it be rheumatoid disease??

Thanks :)

Last edited by

17 Replies

  • Hi ian2347,

    I have put a link to the section on our website about diagnosis that I think you might find useful. People can have a negative result for rheumatoid factor but still have rheumatoid arthritis (RA) (and vice versa). Laboratory tests and imaging techniques are very useful but it is also very important to pay attention to what your body is telling you.

    Hope this helps you


    Beverley (NRAS Helpline)

  • Hi My bloods are normal and have been for the last 9 months since I went to the doctor. as well as a physical examination and talking to me the rheumatologist gave me a intra muscular steroid injection which he described as a "steroid challenge". The aim of this was to see if I got an immediate improvement. when this happened over about 48 hours he said that this meant that I have RA. hope this helps

  • So what happened? Did the steroid challenge work?

  • Yes . Symptoms gone within three days so now on treatment

  • Edited.

  • Ok ignore this, I misread - so sorry! Seronegative RA occurs in about 30% of cases, so not uncommon. Which joints did they scan?

  • If its unlikely to be RD because of the clear blood and MRI scan, why has the rheumatologist been so quick to start me on disease modifying drugs - methotrexate initially and now leflunomide?

    Symptoms are stifness and pain in my joints (neck, shoulders, knees, etc), fatigue, etc

  • I posted underneath and said that I misread, I posted again just above you. :)

  • I don't understand why you think it's unlikely to be RD. Trust your Rheumy, it appear to me from the info you've supplied he's on the ball. You have typical symptoms in stiffness & pain in joints even though MRI & bloods are normal. My bloods are are normal on or off meds & not everyone presents visual inflammation. RD is not the same in everyone as there are many different types & your Rheumy has decided to act quickly with the meds he's prescribed to help prevent further problems. If you take a look at this link, it may explain clearer how RD is not an atypical disease.

  • I'm sero negative for the RF factor too (although positive for the anti-CCP test) and I know I have the disease. And as for a clean MRI scan , well that's great as it means it's been picked up before there's any permanent damage! Doesn't mean it doesn't hurt tho'. But a good chance that once the drugs start working you'll get back to normal in a few months.

    There's a lot of research that shows that there's a treatment window of 12 - 20 weeks after the first symptoms, and if you can get started on drugs during that window then the chances of a better outcome are much improved. So sounds like yourGP and rheumy are on the ball.

  • I agree with helix helix. I am sero negative and was conservatively treated ie just NSAID's for years before receiving DMARD's . I now have a replacement knee and another which requires replacement. I would say don't hesitate before being treated otherwise you may end up with eroded bones.

    Good luck !

  • Hi I too was in the same boat as yourself, both the MRI and bloods came back non RA but i'm in pain in my hands, fingers and feet sometimes so bad i can hardly walk or use my hands properly. I was refered to Rhematology and was seen by a consultant who diagnoised RA and put me on Methotrexate but it didn't agree with me so he put me on Lleflemomide. I was meant to go back to Consultant in December but it was cancelled until Feburary, then cancelled again until May where I saw new consultant who said i seemed a little upset at my care!!!!! Really, when you've had 3 appointments cancelled no blood tests done for 8 months and no care received what would you think??? She gave me a steroid injection in both feet, sent me for x-ray on hands and feet and upped my medication to 20mg a day. I've not been back to GP - Wheres' the point? i'm only costing him money after all. But i'm now experiencing different symptoms, i am covered in brusies head to toe, my fee are really painful and i'm putting on weight instead of taking it off!!! My eyes are dry and really itchy and sore (suspect that the GP would say it's hayfever!) I don't know who to talk to about it all and it's starting to get me down. I'm not a depressive person i have a happy outlook on life i also have a high pain threshold but i'm starting to worry about what's around the corner. I don't think i've really got my head round the fact i've got RA and it's only going to get worse not better. I also don't think we've found the right drugs for me. I was diagnosed in April 2013 and yes lluflomide has worked for a bit but now the pains are coming more often and lingering rather than going away. Next rhumatology appointment is meant to be September - watch this space.

    Thank you for letting me share - feel a bit better now :0)

  • If you feel the leflunomide isn't working & it does sound that way as you're questioning the difference you're noticing in length of pain relief you're doing the right thing & listening to your body. It appears to me that another med needs to be added as a single DMARD isn't seemingly sufficient to control your RD. You don't say how MTX didn't agree with you & guess they were tablets but it if was because of side effects was it suggested you could take it as an injections? They're not without side effects either but, as it bypasses the tum often far fewer. It was probably explained to you but it's generally the first med given as it's considered the gold standard & does have good results in most people & I've found since injecting I have fewer, in fact if I'm honest so few it no longer bothers me & cope as without it I'm rubbish. I take it along with my mix of other drugs of course but MTX is the backbone of all the others I feel. My folic acid was also increased which helped even further. Your progression of RD will only worsen without proper control & as I say just taking the one med doesn't appear to be helping. Were you not prescribed an NSAID? I'd have a word with your GP & see if the appointment can be brought forward as it's likely by the time you see your Rheumy if indeed you do see him in September & that one isn't cancelled you'll risk further damage as the disease progresses without control. If this isn't possible maybe ask if in the interim he's able prescribe you something alongside the LEF to help you in the meantime (he may need to consult your Rheumy in order for him to do this).

    Be assured once the right mix has been found that works best for you you'll think differently about it getting worse & not better. I've been well controlled for 5 years & led a relatively normal life with RD (until recently that is but that's another story, just being honest!).

  • thanks nomoreheels, you've made me feel a bit better. I don't think the GP is overly concerned as he keeps reverting me back to my Rheumy for treatment but the Rheumy wants it to be GP led!!! I think i might make an appointment and see if i can geta a NSAID at the same time. I was taken off methotrexate because of the side effects - i got severe headaches and nausea but he never mentioned the injections. Reading some past questions here and on the NRAS it seems llflumoide works for some but with additonal medication so I think i'll make that appointment at the GP and see what happens.

    Thanks again, I feel a bit more supported now x

  • No probs. The Rheumy is the best professional to treat you, in my opinion, he is the specialist! A GP is just that a General Practitioner so knows a little about a lot otherwise why the need for referral to someone who does, grrr! A little surprised injections weren't offered. The are considerably more expensive but is a good starting med & if not able to tolerate tablets & most often attempted before exploring other drugs. Some even manage with MTX alone if they can get on with it & don't need any other DMARDs, just maybe an NSAID or steroidal treatment infrequently if lucky. Obviously not suitable or enough for some but it depends on how aggressive the RD or the condition being treated. As I said I'm on MTX & also low dose oral steroids, only taking my etoricoxib NSAID COX2 prn at the mo for my RD & although not quite enough to have no pain & in need of an alternative, generally I'm pretty stable. Leflunomide is one I've never taken so can't help on that.

    If you see your GP I do hope he can help. Pain is miserable.

  • For those who were diagnosed with normal MRI, did you have visible synovitis? I ask this because MRI scans can and do show inflammation, not just erosions.

  • spondyloarthritis (the other main form of inflammatory arthritis besides RA) has negative RF, but can be extremely difficult to diagnose in the early years as it can take up to 8 or 10 years to show the damage on xrays or MRI that doctors need to see in order to confirm a diagnosis. As if they were considering spondyloarthritis, and if so, what can you do in the meantime before MRIs are showing positive.

You may also like...