Rheumatoid factor (RF) is the autoantibody (antibody directed against an organism's own tissues) that was first found in rheumatoid arthritis. It is defined as an antibody against the Fc portion of IgG (an antibody against an antibody). 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.
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. The sensitivity of RF for established rheumatoid arthritis is only 60-70% with a specificity of 78%.
Many patients with rheumatoid disease are seronegative to begin with but seroconvertion (becoming positive) occurs in 80% of them.
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.
- Systemic lupus erythematosus (SLE)
- Sjögren's syndrome
- Interstitial pulmonary fibrosis
- Hepatitis B, Chronic liver disease and chronic hepatitis
- Essential mixed cryoglobulinemia
- Primary biliary cirrhosis
- Infectious mononucleosis and any chronic viral infection
- Bacterial endocarditis
- Visceral leishmaniasis
- Systemic sclerosis
- After vaccination/transfusion in normal individuals
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.
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- Rheumatoid Arthritis~workup at eMedicine
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- Rheumatoid Factor - Patient UK
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- The Arthritis Association, Report by MHC 19.2
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- Rose, HM; Ragan, C (1948). "Differential agglutination of normal and sensitized sheep erythrocytes by sera of patients with rheumatoid arthritis". Proceedings of the Society for Experimental Biology and Medicine. 68 (1): 1–6. doi:10.3181/00379727-68-16375. PMID 18863659.