2. Seronegative RA Has Become More Common in Recent YearsAccording to CreakyJoints, a support, education, advocacy, and research organization for people living with arthritis and rheumatic disease, the majority of rheumatoid arthritis patients are seropositive. But while you’re far less likely to be diagnosed with the seronegative type of the disease, those numbers are on the rise, according to a study published in 2020 in Annals of the Rheumatic Diseases. Between 1985 and 1994, only 12 out of 10,000 people with RA were seronegative. Between 2005 and 2014, that number crept up to 20 out of 10,000.3. People With Seronegative RA May Have Different Symptoms, More InflammationThe conventional wisdom is that seropositive patients have more severe symptoms, but recent studies suggest that the difference between the two forms of the disease may have more to do with the joints affected than with the severity of RA symptoms. And a report published in BMC Musculoskeletal Disorders found that further research is needed to better understand the long-term outcomes of patients with seronegative RA. In a European study of 234 people with both types of rheumatoid arthritis who had experienced symptoms for less than two years, those with seronegative RA showed higher levels of inflammation and more affected joints, according to research published in Annals of the Rheumatic Diseases.“My experience has been that while the symptoms are similar, seronegative patients are more difficult to treat,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and a medical adviser to CreakyJoints.RELATED: 5 Warning Signs That Rheumatoid Arthritis Is Getting Worse4. Seronegative RA Could Become Seropositive Down the RoadYour rheumatoid arthritis markers may change over time from negative to positive, since some people with seronegative rheumatoid arthritis begin to develop RF or ACPA antibodies. “It happens, but it’s not that common,” says Dr. Domingues. John J. Cush, MD, a rheumatologist in Dallas, says people with seronegative rheumatoid arthritis may start to develop RF or ACPA within the first two years of diagnosis.Forecasting how any disease may progress is extremely difficult. Whether you’re diagnosed with seronegative or seropositive RA, there are no set expectations about how either form of the disease will play out in an individual. “Which type you have isn’t all that important, since you treat them both the same way,” says Domingues.RELATED: Rheumatoid Arthritis Disease Progression5. Seronegative Rheumatoid Arthritis Doesn’t Need to Be Treated Differently Than SeropositiveThe treatment options available don’t really differ, regardless of what form of the disease you have. “Whether you are diagnosed with negative or positive, be aggressive in treatment and stay ahead of the disease,” advises Dr. Cush. The purpose of treatment in either case is to lessen pain and slow or prevent progression. “Remission as early as possible is the goal,” he says.Standard drug therapy in early disease includes nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil or Motrin) or celecoxib (Celebrex) to help relieve symptoms, and a class of drugs known as disease-modifying antirheumatic drugs (DMARDs) that can help alter the course of the disease, says Domingues. DMARDs include methotrexate (Trexall, Rheumatrex, Otreup, Resuvo) and hydroxychloroquine (Plaquenil). More powerful drugs known as biologics can be prescribed for more severe cases.RELATED: Do You Have “Difficult-to-Treat” RA?6. Seronegative RA Diagnosis May Be Incorrect or May ChangeAccording to Cush and Domingues, a small percentage of people with the seronegative form of RA will do very well on therapy and go into remission, and others will experience severe disease and require medication. And still others will not respond to conventional treatment, which may be because they don’t have RA at all. Eventually, people with seronegative disease may be diagnosed with a different disease altogether, according to the Arthritis Foundation.Spondyloarthritis conditions, which often affect the spine, are sometimes mistaken for seronegative rheumatoid arthritis. A study published in 2021 in Rheumatology found that in over 9,700 patients diagnosed with seronegative RA, almost 9 percent had their diagnosis changed to spondyloarthritis.If, say, a person diagnosed with seronegative RA develops a skin rash, the diagnosis might change to psoriatic arthritis. Other changes or new test results could lead to a new diagnosis of chronic gout or osteoarthritis. “The most important thing at the time you see a rheumatologist is determining whether you have inflammatory arthritis or mechanical arthritis, where there is less that can be done to treat it,” says Domingues.RELATED: Differences Between RA and Mechanical Arthritis