The is a huge "underground" of "sero-negative RA patients" who phenotypically act like sero-+ RA patients in regards to symptoms and steroid responsiveness, but often have more symptoms than signs. This group of patients are subjected to multiple biologic agents in a fruitless effort to meet the rheumatologists' needs for satisfaction and the patient's needs for QOL and functionality. Some type of clinical research is badly needed for this most difficult group, many of which are overtreated with dangerous and expensive medications (sometimes to pay the rent!)