Rheumatoid factor

Overview:

Rheumatoid factor (RF) is a protein (antibody) the body makes against one's tissues. The RF test measures the amount of RF present in the body. RF was initially used to diagnose Rheumatoid arthritis, but it is currently used to diagnose various disease conditions. The RF test, combined with other tests, helps in the easy diagnosis of autoimmune diseases. 

Rheumatoid Factor:

The immune system protects the body against offending organisms by killing them. Antibodies produced during an infection attack the microorganisms in the body. Occasionally, some antibodies recognize the body's organs and tissues as non-self and start attacking them. This causes a disease called the autoimmune disorder. 

The RF is one of the antibodies that can attack one's body organs and tissues and cause damage. These are composed of immunoglobulin G and M, which are the antibodies produced in the body. The immunoglobulin M antibodies act against the IgG, destroying the body's cells. 

This trigger can occur due to genetic or external factors. RF is seen in autoimmune diseases like Rheumatoid arthritis and Sjogren syndrome. Most of the tests that detect RF identify immunoglobulin M. 

Indications:

RF is seen in autoimmune disorders. Clinically high RF can cause the following symptoms

• Joint pains
• Swelling of the joints
• Changes in the skin colour
• Sensation of warmth 
• Fatigue and fevers that occur frequently 

Occasionally, individuals can have high RF in the blood without any clinical symptoms. High RF can also occur for no specific reason. However, most of the time, their levels are raised in autoimmune diseases. 

• Joint diseases like Rheumatoid arthritis
• Salivary gland disease called Sjogren's syndrome
• Joint disease of children called Juvenile Idiopathic Arthritis 
• Lupus 
• Skin and connective tissue disease called Scleroderma 
• Mixed connective tissue diseases 

It is also indicated in long-term infections like 

• Viral Hepatitis C
• Tuberculosis 
• Infective endocarditis 

RF tests also help in the treatment plan and in knowing the prognosis of the disease. 

Advantages:

RF is an autoantibody that is elevated in certain disease conditions. Detecting them in the blood has many advantages:

• It helps in the diagnosis of rheumatoid and non-rheumatoid disorders
• It gives an idea of the present disease condition based on their titer levels
• It helps in assessing the prognosis of the disease
• It also helps in early management of the disease
• It is a simple blood test with no risks or complications

Before the test:

Before undergoing the RF test, an individual should discuss its importance and necessity with the healthcare provider (HCP). The individual should also inform the HCP of all medications taken and the history of previous diseases, infections, surgeries, and allergies. 

During the test:

The Skin at the site where the blood will be withdrawn is carefully swabbed with alcohol, and an elastic band is wrapped around the arm. An individual has to fold the fist to allow the easy flow of blood. Blood is drawn from a vein using a small needle. The required amount of blood is collected in a vial and sent to the lab for evaluation. The area is bandaged. 

The RF test can also be done at home using home test kits with a finger-prick test. After thoroughly cleaning the tip of the finger with an antiseptic, using a needle, the fingertip is pricked to obtain a drop of blood, which is collected on the strip provided by the manufacturer. Following the manufacturer's instructions, the packed strip is sent to the laboratory for analysis. 

After the test: 

After the test, one can continue daily activities. The result values will depend on the laboratory standards. Based on the results, further investigations will be done to confirm the diagnosis, and medications will be prescribed. 

RF Interpretation:

Typical findings in the RF test are negative. Negative RF indicates that there are no autoantibodies in the body. Low levels are seen in normal individuals without any autoimmune disease. However, old age can show slightly higher levels of RF. RF positive indicates the presence of autoantibodies in the body. A high RF factor does not directly indicate autoimmune disease. 

·In Rheumatoid Arthritis: RF is used to diagnose joint diseases like rheumatoid arthritis. Nearly 75% of rheumatoid arthritis patients have positive RF. Increased RF titers indicate a poor prognosis, as the RF titre is directly proportional to the severity of the disease. Individuals with RF negative in early arthritis have slower disease progression. 

• Sjogren's disease is an autoimmune disease affecting the salivary glands. RF is positive in Sjogren's disease even in the absence of Rheumatoid arthritis. 
• Other diseases: RF can be positive in other diseases, such as Lupus, Tuberculosis, syphilis, viral hepatitis, Infectious mononucleosis, and influenza, despite the absence of rheumatoid arthritis. 
• Cancers: Abnormally high levels of RF can be seen in cancers like leukaemia, multiple myeloma, and others. 
• Habits: Individuals who smoke also show high levels of RF. Smoking is one of the risk factors for rheumatoid arthritis. 

Risks and complications: 

There are no risks or complications associated with the RF test. The main risks are soreness of the arm and bruising at the needle insertion site, along with mild dizziness or light-headedness, which subsides after some time. 

Conclusion: 

Rheumatoid factors are autoantibodies that are detected in various rheumatoid and non-rheumatoid diseases. They are one of the important tests done to diagnose rheumatoid arthritis. They help in early diagnosis of the disease, which in turn increases the quality of life of the individuals. 

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