The F-II agglutinating factors in serums of patients with non-rheumatic diseases

Rheumatoid factor by laser nephelometry and Waaler–Rose assay: prognostic value in patients with recent‐onset rheumatoid arthritis

OBJECTIVE

To evaluate the prognostic value of rheumatoid factor (RF), detected in the Waaler-Rose agglutination assay and by nephelometry, in patients with recent-onset rheumatoid arthritis (RA).

METHODS

Consecutive patients with new-onset RA between 1993 and 1997 were followed for a median period of 4.7 years. Clinical data at baseline and drug use during the disease course were recorded. Outcome parameters studied were disease process, damage (erosions, joint surgery, extra-articular manifestations, and new co-morbidity), and death. Cut-off levels for RF were >40 IU/mL (nephelometry) and titres 1:160 (Waaler-Rose haemagglutination).

RESULTS

RF tests were negative by both methods in 22% of RA patients (RF- group), while 33% were RF positive by nephelometry only (RF+ group) and 45% were positive by Waaler-Rose and nephelometry (RF++ group). Baseline clinical and laboratory findings as well as the number of subsequently used disease-modifying anti-rheumatic drugs (DMARDs), the number of patients starting and the time spent on steroid therapy were similar in the three RF groups. Odd ratios for death (n = 23), erosions (n = 62), and serious extra-articular disease manifestations (EAMs) (n = 13) as well as patient survival, erosion-free or surgery-free survival rates did not differ between the RF groups. Only rheumatoid nodules were more frequent in RF++ patients.

CONCLUSION

The baseline presence of RF by either Waaler-Rose or nephelometry was not associated with differences in drug therapy, morbidity other than rheumatoid nodules, or mortality in RA patients in the first 5 years of disease. Being immunoglobulin M (IgM) RF positive thus had little impact on RA patient outcome.

The induction of a rheumatoid factor-like substance in rabbits

Hyperimmunization of two groups of rabbits with killed Escherichia coli and Bacillus subtilis has resulted in the formation of a serum factor (RFLS) which resembled the human rheumatoid factor. It was a heat-stable protein that migrated electrophoretically in the gamma-beta globulin range and sedimented rapidly with ultracentrifugation. The serologic properties of the RFLS were destroyed by mercaptoethanol. It reacted primarily with rabbit gamma globulin in an aggregated state (immune complexes or physically aggregated gamma globulin) and demonstrated cross-reactivity with human gamma globulin.

An investigation on rheumatoid factor of different immunoglobulin classes in hepatitis B virus carriers

Rheumatoid factor (RF) is known to be present very frequently in HB virus carriers. When RF was assayed in 140 asymptomatic carriers by agglutination method, 20.0% were found to be positive, whereas 2.7% in the controls (p less than 0.01). ELISA for detection of RF isotypes showed RF in carriers to be almost IgMRF only. IgMRF showed a tendency to react more readily to human IgG rather than to rabbit IgG. The incidence of IgMRF positivity was higher among anti-HBe antibody-positive carriers than among anti-HBe antibody negative ones, but the difference between the two populations was not significant. However, the incidence of IgMRF positivity in the group showing hepatic dysfunctions was found to be significantly higher than in the group with normal hepatic functions.

Prospective study of the early course of rheumatoid arthritis in young adults: comparison of patients with and without rheumatoid factor positivity at entry and identification of variables correlating with outcome

The early course of newly diagnosed RA among young adult patients (16-44 yr) is described from results of an ongoing study with a mean follow-up of 3.4 yr. Study diagnosis was based on the judgement of experienced rheumatologists, and data on several hundred variables were obtained on entry and annually for the purpose of defining patterns of onset and course of disease. Race and sex factors, as well as certain entry manifestations, e.g., RF, were found to correlate with onset and course patterns. Females, and especially white females, had significantly greater numbers of swollen upper extremity joints than males at entry and at last observation, with increased likelihood of developing bone erosions. At entry, RF positive patients differed only on few articular manifestations from RF negative patients, but had a higher frequency of positive ANA at entry and more subcutaneous nodules and bone erosions during follow-up. Seropositive white females at entry had significantly more swollen upper joints than their seronegative counterparts, but with no difference found at last follow-up. White females of each serogroup had more joint involvement at last examination than patients of other race-sex groups. Males had more acute onset, especially under age 30, with significantly greater improvement in arthritis and in ESR than did females. The majority (55%) of patients entered as seropositive, converted to seronegative during follow-up, and no correlation of either joint swelling or erosions was noted with this phenomenon. At last visit, RF positively did not correlate with bone erosions, but patients developing bone erosions had higher frequency of ANA and higher mean serum complement levels at last examination. The following entry factors were found to correlate significantly with a better outcome: maleness, acute onset under age 30, less swollen upper joints, and negative RF. Type of drug therapy tended to reflect severity of arthritis, rather than vice versa, and functional capacity improved significantly from entry to last evaluation in both males and females, even though the latter had stable or progressive arthritis. Further study is necessary over long intervals and in wider age range to more adequately interpret the biologic implications of findings of this ongoing study. A better understanding of the pathogenesis of RA may be derived from critical studies of the contribution of host factors, e.g., sex, and other variables predisposing to the development of RF positivity (and ANA), subcutaneous nodules, and bone erosions, particularly in systematic ongoing studies of patients with early diagnosed disease.

Autoimmune phenomena in alcholic cirrhosis

Serum immunoglobulins usually are increased impressively in alcoholic cirrhosis, particularly IgA and IgM. The basis for these changes has not been clarified. Previous studies with sera of cirrhotic subjects failed to show autoantibody reactions found in other hepatocellular diseases. Two autoantibody reactions were demonstrated by immunofluorescent techniques, using IgG, IgM, and IgA of cirrhotic sera. Purification was achieved by starch block electrophoresis, gel filtration of Sephadex G-200, chromatography on DEAE-Sephadex, and affinity chromatography on columns of Sepharose 4B, in that sequence. IgM appeared as a nonspecific antinuclear antibody, IgA bound to alcoholic hyaline (Mallory bodies). IgG failed to stain any of the examined tissues. It may be the blocking agent which prevents the above-mentioned autoimmune phenomena in whole serum.

Isolation of diphtheroid bacilli from synovial membrane and fluid in rheumatoid arthritis

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Antibodies against gamma-globulin after repeated blood transfusions in man

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