Coexisting seronegative rheumatoid arthritis and ankylosing spondylitis

Excerpt

We read with great interest the letter of Rothschild. In our practice, the diagnosis of rheumatoid arthritis (RA) with clinical and laboratory findings is not so difficult if the patient has a positive rheumatoid factor. However, similar to other clinicians, we have diagnostic problems in rheumatoid factor-negative patients. The basic diagnostic feature of RA is marginally, symmetrical polyarticular erosions of the joints with periarticular osteopenia, as stated by Rothschild. Other diagnostic criteria of the American College of Rheumatology 1987 criteria may exist in several rheumatic diseases. Specific extra-articular involvements and histocompatibility locus antigens support the diagnosis of RA. However, generally, the diagnosis of extra-articular involvements of RA patients need to be corrected by experienced physicians. Similar to our patient, women patients with spondyloarthropathy may be misdiagnosed as seronegative RA because of the frequent peripheral onset of the arthritis. In such complex cases, it is possible to make mistakes in diagnosis with the present criteria. In this point of view, we agree with Rothschild. …