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Review
. 2013;35(6):727-34.
doi: 10.1155/2013/726598. Epub 2013 Nov 13.

Rheumatoid factors: clinical applications

Francesca Ingegnoli  1 , Roberto Castelli, Roberta Gualtierotti
Affiliations
Review

Rheumatoid factors: clinical applications

Francesca Ingegnoli et al. Dis Markers. 2013.

Abstract

Rheumatoid factors are antibodies directed against the Fc region of immunoglobulin G. First detected in patients with rheumatoid arthritis 70 years ago, they can also be found in patients with other autoimmune and nonautoimmune conditions, as well as in healthy subjects. Rheumatoid factors form part of the workup for the differential diagnosis of arthropathies. In clinical practice, it is recommended to measure anti-cyclic citrullinated peptide antibodies and rheumatoid factors together because anti-cyclic citrullinated peptide antibodies alone are only moderately sensitive, and the combination of the two markers improves diagnostic accuracy, especially in the case of early rheumatoid arthritis. Furthermore, different rheumatoid factor isotypes alone or in combination can be helpful when managing rheumatoid arthritis patients, from the time of diagnosis until deciding on the choice of therapeutic strategy.

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Figures

Figure 1
Figure 1
Proposed decision-making algorithm for patients who are rheumatoid factor positive at the first evaluation. RF: rheumatoid factor; RA: rheumatoid arthritis; ACPA: anti-cyclic citrullinated protein/peptide antibody.
Figure 2
Figure 2
Role of rheumatoid factors in the management of rheumatoid arthritis patients.
Figure 3
Figure 3
The immunological role of rheumatoid factors (RFs) in rheumatoid arthritis. RFs may be produced both in a T cell-dependent or T cell-independent pathway. Macrophages and B cells may act as antigen-presenting cells and efficiently present antigens to T cells. Ag: antigen; BCR: B cell receptor; TCR: T cell receptor; RF-PCs: rheumatoid factor plasma cells; IC: immune complex.
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