NRAS
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What’s the difference?

Can I ask...... I have seronegative inflammatory arthritis. What is the difference between positive and negative? I know it means I don’t have the factor (whatever it’s called) but what does it mean? Like what do I not have that the positive people have? Someone said it means I wouldn’t get the deformities side but I’m not sure that’s true. And I understand I could end up being positive so want to know what the difference is please 😄 xxx

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Sweet FA, so really don't let it bother you too much.

It is said that you will have a higher probability of having a less aggressive disease, and are less likely to suffer erosions and deformities if you are negative. However based on people's stories on here that is by no means true for everyone who is sero-negative. It can also mean that it takes a lot longer to be diagnosed for sure as being positive for RF and anti-CCP tends to convince doctors more quickly that you saying you are in agony.

What you don't have is antibodies in your blood that are produced by your immune system in response to attack by various types of invading things. However, they may develop later. And for RF a lot of people do have this antibody and don't have an inflammatory arthritis.....so it's not hugely specific. (The anti-CCP is more specific, if you are positive for this then something like 85% probability that you have RA)

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In terms of pain, deformity and aggressiveness... Nowt! I think it just takes longer to get taken seriously (in my case anyhoo).

Helixhelix as explained the rest better than I could.

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It's all down to anti-CCP (anti-Cyclic Citrullinate Peptide). It's an antibody that our body either produces (seropositive) or doesn't (seronegative). It's a newer & more reliable (but more expensive) test than good old RF (Rheumatoid Factor). Those of us with seropositive RD have generally been thought by those in the know to be diagnosed easier & potentially have more aggressive joint erosion though that can't always be the case as I've been spared it on the whole, apart from my feet where erosion was found at diagnosis. This may have been due to no serious extensive signs of RD before I went to my GP & that I started treatment very quickly after my feet were first painful, I'd say it's subjective though. It's important to remember though that this test alone isn't able to definitively confirm RD, it's just one piece of the jigsaw.

Seropositivers are also more likely to collect add-on's such as rheumatoid nodules, vasculitis, Sjögren's & cardiopulmonary complications. I know from experience they take particular care with prescribing meds that have a tendency to be problematic heart-wise whether RD related like NSAIDs or not, that & I have family history of heart disease on both sides. Basically they've got me either way as I also have personal history of lung issues so I'm happy to have the checks! My GP also performs a full cardiovascular check annually & checks out my Qrisk (cardio prediction algorithm) too. You're correct in thinking it's possible for a seronegative diagnosis to develop into a seropositive one over time, quite why doesn't seem to be known, just one of those idiosyncrasies of RD! Neither do they fully know why some have developed the anti-CCP antibodies prior to diagnosis yet others who tested negative can later, I guess these along with other scratchy head issues of RD show why it's proven difficult so far to find a 'cure'.

Hope some of this makes sense Helen, & it helps. If anything it's not really something I'd concern yourself about too much, best to concentrate on the here & now is how I look at it. If it was just idle thinking then I hope you've a better idea now, & that I've got it right! x

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What about those of us that are positive for rheumatoid factor but negative for anti CCP? Are we seropositive or not? I thought I was, but your answer contradicts this, so now I’m not sure

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Traditionally a positive RF was considered sero-positive (this was the first test introduced) and anti-CCP was shown separately. These days it seems that you are classed as sero-positive if you have either or both positive.

My first rheumy was a traditionalist so I was classed as sero-positive, and with positive anti-CCP.

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That's because I was basing my reply on the most up to date testing & the more reliable test used to form a diagnosis on. If you like it can be &/or because RF (also an antibody test) can also show positive, so if you tested RF positive it's possible your Rheumy considered, possibly if the result was a strong positive, that was proof enough to give a diagnosis of seropositive. Even now GP's usually only test for RF & if it's a positive result they'll refer to Rheumatology, one reason it can take a while, or symptoms dismissed if the result is negative & why I wish anti-CCP was more widely used in initial testing. In fact prior to the anti-CCP being introduced RF was the only antibody blood test used in secondary care so when you were diagnosed could also have some bearing, if it was pre or early anti-CCP then there's your answer. Nowadays the anti-CCP is more reliable, especially so since it's evolved through 3 generations, with each the specificity & sensitivity has improved. Plus of course there are other criteria which need to be met to form a seropositive or seronegative diagnosis, it's not only blood tests that form a diagnosis. For your own medical notes you'd be best to ask your Rheumy to confirm which he forms his diagnoses on. Hope this clarifies. x

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If you’re up for a bit of reading 📖 , Hels1989, these explain nicely:

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Seropositive ➕ and Seronegative➖ explanations:

➕ ➖ Seropositive & Seronegative: nras.org.uk/seropositive-se...

➕ ➖ What ‘Type’ of RA Do You Have?: arthritis.org/about-arthrit...

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Seropositive Rheumatoid Arthrits: rheumatoidarthritis.org/ra/...

Seronegative Rheumatoid Arthrits: rheumatoidarthritis.org/ra/...

➖ 'Seronegativity for Dummies: A Lesson in Seronegative Blood Results' [with additional references 🔗 from 'Chronic Curve' 🌀🌀 (Emily Bradley)]: chroniccurve.tumblr.com/pos...

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➕ ➖ "Seropositive Seronegative" google search results: google.com/search?as_q=Sero...

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🙏 🍀 🌺 🌞

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[If you’d like to wade deeper into the weeds 🌾🌾🌾, kindly see ... 3-Part 'Serology (RF, ACPA, Anti-CCP, ANAs, ANCA) in Rheumatology' Series ...: healthunlocked.com/nras/pos...

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I have Sereopositive. I thought the only difference is what shows up in a blood test, meaning Seropositive RA is easily diagnosed if shows up in blood tests. But truly I don't think anything as we all get the pain etc

Best wishes pamela x

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I’m also seronegative and had the same questions. I’m glad you asked because now I know a bit more.

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