Differentiate to Diagnose: Seronegativity Signals Complexity

Chronic lung conditions, chronic liver disease, and chronic renal disease can elevate levels of rheumatoid factors that do not indicate rheumatoid arthritis unless accompanied by synovitis. This confusion often arises with patients exhibiting osteoarthritis and seropositivity. Additionally, CCP antibodies are frequently associated with chronic lung diseases like ILD and can be present in anti-synthetase syndrome and some cases of psoriatic arthritis. The occurrence of seronegativity is common, necessitating a distinct diagnostic approach for such cases, despite potential symptomatic similarities to rheumatoid arthritis. Clinicians should consider alternative diagnoses when facing seronegative rheumatoid arthritis.