hello all. Looking for advice. The past 2 years I have seen a rheumatologist because I had a swollen joint. Since then he’s done several blood tests which show Seronegative. My inflammation blood markers are normal. The last Xray showed mild deminerialization of some joints and osteoarthritis of some joints.
I have stiffness of finger joints in the morning but no swelling.
Can ra be diagnosed on Xray alone? Any advice is greatly appreciated. Thanks
An X-ray would show joint erosion/OA but not RA. Rheumys regularly use ultrasound to diagnose RA in more recent years. I had mine diagnosed by an isotope bone scan but that was 27 years ago. Have a look on the diagnosing RA section on the NRAS website for more info on diagnostic methods.
Thanks for a quick response. I’ll take a look at the site. Thanks
Hiya Grams, welcome to the NRAS site. As NK (above) says, X-rays alone wouldn't be relied upon alone as a diagnosis but as one piece of the jigsaw, if you have any erosions, more of a baseline test to compare in the future really. Blood tests &, more helpful, examination of joints are other pieces, sometimes your family history too.
A seronegative diagnosis, just as with a seropositive diagnosis, is treated with DMARDS & other commonly prescribed meds such as NSAIDs. I take it you are receiving treatment? Just wondering with you saying you only have the one joint involvement. Your OA whilst considered wear & tear may benefit from treatment too, pain relief &/or NSAIDs to make you more comfortable, though this may have been suggested. Often this would be under the care of your GP.
Did your Rheumy discuss you having a DXA scan any time soon? It might be an idea to have a baseline of the demineralisation. Whilst mild it still exists & maybe something to consider asking about if it's not been recommended.
I hope some of this helps. You might find it helpful to have a read through the NRAS website nras.org.uk Anything else your need help with just ask, there's always someone around to answer queries or ask experiences of.
so in late stages of RA, it can be obvious that have RA, with loss of joint space and cartilage, and typical erosions. This usually takes years to show though. Ultrasound & mri are used more these days. X-rays and scans are only part of the picture.
It’s worth getting a dexa scan to look at the demineralisation which can indicate osteopenia of osteoporosis.
hi
your negative blood tests are not seronegative thats only if your diagnosed. Xrays show bone erosion which can happen with ra. Ultrasounds and mris are used for inflammation. Usually ra affects more than one joint but its not unheard of
X-rays can help make a diagnosis by what they don’t show as well as what they do show. That, with blood tests, family history and a physical exam goes to make a diagnosis. RA is rarely diagnosed on one thing alone.
I'm sero negative. I was diagnosed with ultrasound 15 years' ago
If you have one speak to your rheumatology nurse….she will have access to all your test results & will be able to explain any treatment you may be offered.Compose a list of your questions & get things straight in your mind.You need to know what to expect…& as you will no doubt realise from the answers youwill get herev……it is not straightforward ……& we are all different.
Thank you all! Great advice! I have an appointment in Nov with my rheumatologist. I’ll have my questions ready and see how it goes from there.
i am seronegative I was diagnosed finally by ultrasound which I understand is a common method
my doctor feels my joints. I can’t see any swelling and my joints aren’t sore. It is my tendons and ligaments that are sore. This whole umbrella of inflammatory diseases are confusing and I wish I could get a second opinion but I am in Canada so not an option. Ultrasound & MRI have never been used to diagnose me.
Hi smilelines. I'm in Canada as well. I have never noticed any swelling except that initial finger. Blood markers CRP and sed rate have been normal. RF and anti CCP are negative. I haven't had an ultrasound or MRI either but I'm going to ask at my next appointment. What treatment are you on?
I am on leflunimide but apparently my disease is still severe so she wants to put me on biologics. I picked Cosentryx when she gave me a few choices as it doesn’t put a person at risk of MS side effects At least that is what she said. Apparently some of the biologics do have a slight risk of that. This is so frustrating because when. I exercise my hands get super stiff and also my right leg. This apparently isn’t how inflammatory arthritis usually acts . My fingers are stiff in the morning but they don’t really change during the day. Are your fingers less stiff or more stiff with physical exercise? I mean exercise that gets your heartbeat up not finger exercises. It would be helpful for me to have actual evidence of some sort of physical deterioration or something other than her telling me my joints are swollen when I can’t see the swelling or feel pain from it. Maybe I Am just in denial and I don’t even know what it is like to feel good anymore so I think I am ok I hope you can get some convincing type evidence that you are on the right track. All my blood tests are normal too. I am in Alberta. Are you out west or east?
I’m in Ontario. I’m not on any treatment presently. I was prescribed a generic type of Plaquenil in February but had a reaction from it, so it was stopped. I am an in office appointment in July and nothing was prescribed. He is reluctant because I have a liver disease and many of the treatments could damage my liver. I am to let him know if I get worse. My fingers are stiff sometimes in the morning but go away. Never any swelling. I find they are most sore after using them for a prolong time…. like peeling a bag of potatoes. But I have OA as well. Physical exercise as in running does not affect me. I’m confused as well. How do I know if I’m getting worse if there is no inflammation? If it’s the inflammation that does the damage to the joints , is there damage if I don’t have it? I do have stiffness but could that be my O A?
Does your rheumatologist touch your joints and feel for bogginess? That is what mine does. Sounds like your doctor is really on the ball in protecting your liver. I know Methotrexate and leflunimide are hard on the liver and I think sulfasaluzine is too. Maybe the only one not hard on the liver is hydrochloroquine but I am not sure how effective it is. I don’t think biologics are hard on the liver but they are super expensive. I don’t understand any of this. If inflammatory markers are normal does that mean the test is inaccurate for testing us for inflammation? If we can’t see the inflammation and if the blood is normal does that mean milder damage to our organs and joints? Or just that the test is not accurate in detecting our type of inflammation. I really have no idea. I think it is good that your doctor is going slowly with the medication. I am thinking of begging for a requisition for a hand/wrist MRI from my family doctor. I would be willing to pay for the MRI in the hope I could get a better understanding of what is happening. The last time I asked he said no though. I don’t feel like I have severe disease activity so 🤷♀️. My OA can be seen on an X-ray and it doesn’t make me stiff. just sore.
I feel exactly the same 🤷♀️ Good luck on your ra journey. Keep in touch. It’s nice to have a fellow Canuck ❤️
I'm seropositive and had x-rays to set a baseline. The consultant said he'd be very surprised to see joint damage so early in my progression and he was right even though I was feeling a lot of pain in the joints. I guess the X-rays are useful to check how well the illness is being managed. MRI showed that my tendons were inflamed which didn't show on X-ray. The consultant used the 'sponginess' of my finger joints as a big indication - I didn't even notice it myself.
thanks for your reply….always appreciate reading everyone’s journey 
Hi, I am also seronegative ..psoriatic arthritis. I have awful inflammation in fingers and joints. My inflammation markers are normally normal even although I am in a flare. I have been diagnosed on the fact I have had psoriasis, swelling is symmetrical and a scan will show inflammation. I also have osteoarthritis waiting for a knee replacement. I do think an ultra scan is the way to go. Best wishes.
Hello 👋
I’m seropositive, my bloods showed severe inflammation. I had an X-ray of my feet and hands when my joints originally started hurting, they did show wear and tear on my hands but not my feet, even though I could hardly walk. That was 4 years ago, I’ve been on DMARDS ever since.
But now my larger joints, shoulders and hips seem to be worse, so last year I had a nuclear bone scan and an MRI, these seem to be better showing inflammation than just a normal X-ray.
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