What is a rheumatoid factor?

Rheumatoid factor (RF) is the autoantibody (antibody directed against an organism's own tissues) that is most relevant in rheumatoid arthritis. It is defined as an antibody against the Fc portion of IgG. RF and IgG join to form immune complexes that contribute to the disease process

Rheumatoid factor can also be a cryoglobulin (antibody that precipitates on cooling of a blood sample); it can be either type 2 (monoclonal IgM to polyclonal IgG) or type 3 (polyclonal IgM to polyclonal IgG) cryoglobulin.

Rheumatoid factor can be of either isotype of immunoglobulins, i.e. IgA, IgG, IgM, IgE, IgD.

Testing

RF is often evaluated in patients suspected of having any form of arthritis even though positive results can be due to other causes, and negative results do not rule out disease. But, in combination with signs and symptoms, it can play a role in both diagnosis and disease prognosis. It is part of the usual disease criteria of rheumatoid arthritis.

The presence of rheumatoid factor in serum can also indicate the occurrence of suspected autoimmune activity unrelated to rheumatoid arthritis, such as that associated with tissue or organ rejection. In such instances, RF may serve as one of several serological markers for autoimmunity.

Interpretation

High levels of rheumatoid factor (in general, above 20 IU/mL, 1:40, or over the 95th percentile; there is some variation among labs) occur in rheumatoid arthritis (present in 80%) and Sjögren's syndrome (present in 70%).The higher the level of RF the greater the probability of destructive articular disease It is also found in Epstein-Barr virus or Parvovirus infection and in 5-10% of healthy persons, especially the elderly.

There is an association between rheumatoid factor and more persistently active synovitis, more joint damage and greater eventual disability.

Rheumatoid factor may also be elevated in: chronic hepatitis, primary biliary cirrhosis, any chronic viral infection, bacterial endocarditis, leukemia, dermatomyositis, infectious mononucleosis, systemic sclerosis, and systemic lupus erythematosus (SLE

History

The test was first described by Norwegian Dr Erik Waaler in 1940 and redescribed by Dr H.M. Rose and colleagues in 1948. Redescription is said to be due to the uncertainties due to World War II. It is still referred to as the Waaler-Rose test