Therapeutic intervention in rheumatoid arthritis: a case-controlled comparison of seronegative and seropositive disease.

The records of 684 patients with rheumatoid arthritis (RA) attending a referral centre were evaluated. All available patients (62 cases) with definite seronegative disease were matched, where possible, for sex, age and year of onset with seropositive controls (54 cases). Seronegative females were just as likely as those who were seropositive to require treatment with disease-modifying antirheumatic drugs, whereas seronegative males were significantly less likely to do so than seropositive controls. There were no major differences in outcome or drug toxicity. Orthopaedic surgery was equally common in the two groups, with a similar spectrum of procedures, but there was a trend towards more frequent upper limb large joint arthroplasty in the seronegative group, and this was particularly evident when elbow prostheses were considered. Seronegative rheumatoid disease (at least in females) may be as severe as seropositive disease in a referral-centre population and should be treated with similar vigour.