Rheumatoid Arthritis With Negative RF and Anti-CCP? Solve the Case

Laura is 38. Eight weeks of swollen hands, an hour of morning stiffness — and both rheumatoid factor and anti-CCP come back negative. Do you close the case? In under nine minutes you get three tools: the map of the joints rheumatoid arthritis hits, the full 2010 ACR/EULAR classification criteria, and the decision you can defend when the score falls short. CHAPTERS 0:00 Would you rule it out? 0:36 Laura's history and exam 1:06 Arthralgia is not synovitis 1:29 Which joints does RA hit? 1:56 Inflammatory or mechanical? 2:19 Inside the joint 2:46 The immune machinery 3:12 Rheumatoid factor and anti-CCP 3:44 2010 ACR/EULAR criteria 4:14 Scoring Laura: 5 of 10 4:33 Classifying is not diagnosing 5:00 Ultrasound and radiograph 5:28 The referral note 5:52 Treatment: methotrexate, weekly 6:20 Treat to target 6:48 A different patient: the hot knee 7:14 Test yourself: four questions 7:52 One-page review 8:06 Your turn YOUR TURN If Laura's CRP were normal too, which finding would still guide your next step? Answer in the comments. ABOUT THIS VIDEO Independent educational content for medical students and trainees. Laura is a fictional patient. This is not medical advice and does not replace clinical judgment, supervision, or current local guidelines. Not affiliated with any exam board, society, or guideline body. REFERENCES 1. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria. Ann Rheum Dis. 2010;69(9):1580-1588. https://doi.org/10.1136/ard.2010.138461 2. Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis: a review. JAMA. 2018;320(13):1360-1372. https://doi.org/10.1001/jama.2018.13103 3. van Steenbergen HW, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann Rheum Dis. 2017;76(3):491-496. https://doi.org/10.1136/annrheumdis-2... 4. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365(23):2205-2219. https://doi.org/10.1056/NEJMra1004965 5. Nishimura K, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med. 2007;146(11):797-808. https://doi.org/10.7326/0003-4819-146... 6. National Institute for Health and Care Excellence. Rheumatoid arthritis in adults: management (NG100). 2018, updated 2020. https://www.nice.org.uk/guidance/ng100 7. Kaeley GS, Bakewell C, Deodhar A. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther. 2020;22(1):1. https://doi.org/10.1186/s13075-019-20... 8. van Nies JA, et al. What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review. Ann Rheum Dis. 2014;73(5):861-870. https://doi.org/10.1136/annrheumdis-2... 9. Fraenkel L, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2021;73(7):1108-1123. https://doi.org/10.1002/art.41752 10. Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3-18. https://doi.org/10.1136/ard-2022-223356 11. Shea B, et al. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database Syst Rev. 2013;(5):CD000951. https://doi.org/10.1002/14651858.CD00... 12. Ravn C, et al. Guideline for management of septic arthritis in native joints (SANJO). J Bone Jt Infect. 2023;8(1):29-37. https://doi.org/10.5194/jbji-8-29-2023 CREDITS Ultrasound image (5:00): Kaeley GS, Bakewell C, Deodhar A. Arthritis Res Ther. 2020;22(1):1, Figure 2C. Licensed under CC BY 4.0 (https://creativecommons.org/licenses/.... Cropped. It is a published example, not this patient. All other drawings are original. Music: "Slow Stride" by isaiah658 (CC0, opengameart.org). Sound effects: Kenney (kenney.nl) and artisticdude (opengameart.org), CC0. Handwriting font: Architects Daughter (SIL Open Font License). #RheumatoidArthritis #Rheumatology #MedicalStudents