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Origin and utility of measurement of rheumatoid factors

Author
Robert H Shmerling, MD
Section Editor
Mark H Wener, MD
Deputy Editor
Paul L Romain, MD

INTRODUCTION

Rheumatoid factors are antibodies directed against the Fc portion of immunoglobulin G (IgG). The rheumatoid factor (RF), as initially described by Waaler and Rose in 1940 and as commonly measured in clinical practice, is an IgM RF, although other immunoglobulin types, including IgG and IgA, have been described.

Testing for RF is primarily used for the diagnosis of rheumatoid arthritis (RA); however, RF may also be present in other rheumatic diseases and chronic infections.

The origin of rheumatoid factors and the clinical utility of their measurement are reviewed here. Discussions of clinically useful biologic markers in RA, including rheumatoid factor, and of the diagnosis of RA are presented separately. (See "Biologic markers in the diagnosis and assessment of rheumatoid arthritis" and "Diagnosis and differential diagnosis of rheumatoid arthritis".)

PATHOPHYSIOLOGY

The origin of rheumatoid factor (RF) is incompletely understood [1,2]. An abnormal immune response appears to select, via antigenic stimulation, high-affinity RF from the host’s natural antibody repertoire [3]. This may occur in rheumatic diseases, such as rheumatoid arthritis (RA), and in a number of inflammatory diseases characterized by chronic antigen exposure, such as subacute bacterial endocarditis (SBE). The development of RF after such infections has suggested that they represent an antibody response to antibodies that have reacted with microbes. This possibility is supported by experimental evidence showing that mice immunized with IgM-coated vesicular stomatitis virus (VSV) develop rheumatoid factors [4].

Normal human lymphoid tissue commonly possesses B lymphocytes with RF expression on the cell surface. However, RF is not routinely detectable in the circulation in the absence of an antigenic stimulus. Modified immunoglobulin G (IgG) could be a stimulus to RF production and could be an important component of RA pathogenesis; this concept is supported by studies that observed an association of RF and more severe RA with autoantibodies to advanced glycated end-product (AGE)-damaged IgG or agalactosyl IgG [5,6].

            

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Literature review current through: Nov 2016. | This topic last updated: Mon Jan 11 00:00:00 GMT+00:00 2016.
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