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. 1983 Dec;42(6):605–612. doi: 10.1136/ard.42.6.605

The hand radiograph as a diagnostic discriminant between seropositive and seronegative 'rheumatoid arthritis': a controlled study.

T M Burns, A Calin
PMCID: PMC1001313  PMID: 6651364

Abstract

Although traditional teaching emphasises that 70-80% of patients with rheumatoid arthritis have positive serological tests for rheumatoid factor, a review of the evidence suggests that the seronegative group has distinctive characteristics. In a blinded and controlled evaluation of hand and wrist films we correctly identified the serological status of 43 out of 46 patients satisfying the ARA criteria for 'definite RA'. The radiographic appearances of the seronegative group differed significantly from those of the seropositive group in (1) degree of juxtalesional osteosclerosis (p less than 0.001); (2) the relative absence of classical subchondral erosions (p less than 0.001); (3) presence of new bone formation (p less than 0.001); (4) more fusion (p less than 0.001); (5) more asymmetrical joint involvement (p less than 0.001); and (6) predominant carpal involvement (p less than 0.001). The nature of the destructive process, as defined radiologically, may be different in patients with seropositive rheumatoid arthritis from that seen in individuals with so-called 'seronegative rheumatoid arthritis'.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alarcón G. S., Koopman W. J., Acton R. T., Barger B. O. Seronegative rheumatoid arthritis. A distinct immunogenetic disease? Arthritis Rheum. 1982 May;25(5):502–507. doi: 10.1002/art.1780250503. [DOI] [PubMed] [Google Scholar]
  2. Alarcón G. S., Koopman W. J., Schrohenloher R. E. Differential patterns of in vitro IgM rheumatoid factor synthesis in seronegative and seropositive rheumatoid arthritis. Arthritis Rheum. 1982 Feb;25(2):150–155. doi: 10.1002/art.1780250206. [DOI] [PubMed] [Google Scholar]
  3. BALL J., LAWRENCE J. S. Epidemiology of the sheep cell agglutination test. Ann Rheum Dis. 1961 Sep;20:235–243. doi: 10.1136/ard.20.3.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. BLAND J. H., BROWN E. W. SERONEGATIVE AND SEROPOSITIVE RHEUMATOID ARTHRITIS: CLINICAL, RADIOLOGICAL, AND BIOCHEMICAL DIFFERENCES. Ann Intern Med. 1964 Jan;60:88–94. doi: 10.7326/0003-4819-60-1-88. [DOI] [PubMed] [Google Scholar]
  5. Calin A., Marks S. H. The case against seronegative rheumatoid arthritis. Am J Med. 1981 May;70(5):992–994. doi: 10.1016/0002-9343(81)90846-9. [DOI] [PubMed] [Google Scholar]
  6. Cats A., Hazevoet H. M. Significance of positive tests for rheumatoid factor in the prognosis of rheumatoid arthritis. A follow-up study. Ann Rheum Dis. 1970 May;29(3):254–260. doi: 10.1136/ard.29.3.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Corke C. F., Huskisson E. C. Factors affecting the development of penicillamine side-effects. Rheumatol Rehabil. 1978 Feb;17(1):34–37. doi: 10.1093/rheumatology/17.1.34. [DOI] [PubMed] [Google Scholar]
  8. DIXON A. S. "Rheumatoid arthritis" with negative serological reaction. Ann Rheum Dis. 1960 Sep;19:209–228. doi: 10.1136/ard.19.3.209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dobloug J. H., Førre O., Kåss E., Thorsby E. HLA antigens and rheumatoid arthritis. Association between HLA-DRw4 positivity and IgM rheumatoid factor production. Arthritis Rheum. 1980 Mar;23(3):309–313. doi: 10.1002/art.1780230307. [DOI] [PubMed] [Google Scholar]
  10. Elkon K. B., Hughes G. R., Bywaters E. G., Ryan P. F., Inman R. D., Bowley N. B., James M. P., Eady R. A. Adult-onset Still's disease. Twenty-year followup and further studies of patients with active disease. Arthritis Rheum. 1982 Jun;25(6):647–654. doi: 10.1002/art.1780250607. [DOI] [PubMed] [Google Scholar]
  11. Espinoza L. R., Vasey F. B., Gaylord S. W., Dietz C., Bergen L., Bridgeford P., Germain B. F. Histocompatibility typing in the seronegative spondyloarthropathies: a survey. Semin Arthritis Rheum. 1982 Feb;11(3):375–381. doi: 10.1016/0049-0172(82)90058-0. [DOI] [PubMed] [Google Scholar]
  12. Gordon D. A., Stein J. L., Broder I. The extra-articular features of rheumatoid arthritis. A systematic analysis of 127 cases. Am J Med. 1973 Apr;54(4):445–452. doi: 10.1016/0002-9343(73)90040-5. [DOI] [PubMed] [Google Scholar]
  13. Gottlieb N. L. Chrysotherapy. Bull Rheum Dis. 1976;27(7):912–917. [PubMed] [Google Scholar]
  14. Jaffe I. A. The effect of penicillamine on the laboratory parameters in rheumatoid arthritis. Arthritis Rheum. 1965 Dec;8(6):1064–1079. doi: 10.1002/art.1780080606. [DOI] [PubMed] [Google Scholar]
  15. KELLGREN J. H., BALL J. Clinical significance of the rheumatoid serum factor. Br Med J. 1959 Feb 28;1(5121):523–531. doi: 10.1136/bmj.1.5121.523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lawrence J. S. Heberden Oration, 1969. Rheumatoid arthritis--nature or nurture? Ann Rheum Dis. 1970 Jul;29(4):357–379. doi: 10.1136/ard.29.4.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mongan E. S., Atwater E. C. A comparison of patients with seropositive and seronegative rheumatoid arthritis. Med Clin North Am. 1968 May;52(3):533–538. [PubMed] [Google Scholar]
  18. Mongan E. S., Cass R. M., Jacox R. F., Vaughen J. H. A study of the relation of seronegative and seropositive rheumatoid arthritis to each other and to necrotizing vasculitis. Am J Med. 1969 Jul;47(1):23–35. doi: 10.1016/0002-9343(69)90238-1. [DOI] [PubMed] [Google Scholar]
  19. Panayi G. S., Wooley P. H., Batchelor J. R. HLA-DRw4 and rheumatoid arthritis. Lancet. 1979 Mar 31;1(8118):730–730. doi: 10.1016/s0140-6736(79)91186-3. [DOI] [PubMed] [Google Scholar]
  20. ROPES M. W., BENNETT G. A., COBB S., JACOX R., JESSAR R. A. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958 Dec;9(4):175–176. [PubMed] [Google Scholar]
  21. Scherak O., Smolen J. S., Mayr W. R. Rheumatoid arthritis and B lymphocyte alloantigen HLA-DRw4. J Rheumatol. 1980 Jan-Feb;7(1):9–12. [PubMed] [Google Scholar]
  22. Sharp J. T., Lidsky M. D., Collins L. C., Moreland J. Methods of scoring the progression of radiologic changes in rheumatoid arthritis. Correlation of radiologic, clinical and laboratory abnormalities. Arthritis Rheum. 1971 Nov-Dec;14(6):706–720. doi: 10.1002/art.1780140605. [DOI] [PubMed] [Google Scholar]
  23. Skrifvars B. V., Törnroth T. S., Tallqvist G. N. Gold-induced immune complex nephritis in seronegative rheumatoid arthritis. Ann Rheum Dis. 1977 Dec;36(6):549–556. doi: 10.1136/ard.36.6.549. [DOI] [PMC free article] [PubMed] [Google Scholar]

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