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Rheumatoid Factor (RF)

Immunity
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Report in 4Hrs

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Details

Rheumatoid factor test used in diagnosis of rheumatoid arthritis and other autoimmune conditions.

₹299₹495

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Rheumatoid Factor (RF) - Comprehensive Medical Test Guide

  • Why is it done?
    • Test measures antibodies (specifically IgM, IgG, or IgA) produced by the immune system that attack the body's own tissues, particularly affecting joints and connective tissue
    • Primary indication: Diagnose or confirm rheumatoid arthritis (RA) when joint pain, swelling, and stiffness are present
    • Evaluate other autoimmune conditions such as systemic lupus erythematosus (SLE), Sjögren's syndrome, and mixed connective tissue disease
    • Assess disease activity and severity in patients already diagnosed with RA
    • Monitor treatment response and prognosis in autoimmune disease management
    • Typical timing: Performed during initial diagnostic workup when symptoms suggest autoimmune disease, or periodically during disease monitoring
  • Normal Range
    • Normal/Negative Result: Less than 14 IU/mL (International Units per milliliter) or negative on qualitative testing
    • Borderline/Weakly Positive: 14-20 IU/mL - may warrant repeat testing or additional evaluation
    • Positive Result: Greater than 20 IU/mL - indicates presence of rheumatoid factor antibodies
    • Highly Positive: Greater than 60 IU/mL - suggests higher likelihood of RA or other autoimmune disease
    • Units of measurement: IU/mL (International Units per milliliter) or may be reported as positive/negative or as a titer
    • Note: Reference ranges may vary slightly between laboratories; consult your specific lab's reference interval
    • Normal result indicates absence of detectable rheumatoid factor, suggesting lower likelihood of RA; however, seronegative RA exists in 20-30% of patients
  • Interpretation
    • Positive RF Result (>20 IU/mL): Suggests autoimmune activity; when combined with clinical symptoms (joint pain, swelling, morning stiffness), strongly supports RA diagnosis
    • Negative RF Result (<14 IU/mL): Does not exclude RA diagnosis; seronegative RA occurs in approximately 20-30% of RA patients; further testing with anti-CCP antibodies recommended
    • High Titers (>60 IU/mL): Associated with more severe disease, increased risk of extra-articular manifestations (nodules, vasculitis), and worse prognosis
    • Borderline Results (14-20 IU/mL): Warrant repeat testing in 4-6 weeks; trending upward increases diagnostic likelihood
    • Factors affecting results:
    • Age: RF positivity increases with age; may be positive in 5-10% of healthy elderly individuals
    • Gender: More common in women; female-to-male ratio approximately 2.5:1 for RA
    • Infections: Certain infections (hepatitis C, tuberculosis, EBV) can elevate RF transiently
    • Disease activity: RF levels may fluctuate with disease activity in established RA; poor correlation with symptom severity
    • Early disease: RF may not appear until several months after symptom onset
    • Clinical significance:
    • RF-positive patients have worse long-term outcomes compared to RF-negative patients
    • Used in combination with anti-CCP antibodies for improved diagnostic accuracy (RF+/anti-CCP+ has highest specificity)
    • Helps stratify risk for severe disease and need for aggressive treatment
  • Associated Organs
    • Primary organ systems involved:
    • Musculoskeletal system: Primarily affects synovial joints; inflammatory cascade leads to cartilage and bone destruction
    • Immune system: B and T lymphocyte dysfunction; immune complex formation and deposition
    • Connective tissue: Systemic inflammation affecting multiple tissue types
    • Conditions commonly associated with abnormal RF results:
    • Rheumatoid Arthritis (RA): Most common autoimmune condition associated with elevated RF; positive in 70-80% of RA patients
    • Systemic Lupus Erythematosus (SLE): Positive RF in 40-60% of SLE patients; indicates more severe disease
    • Sjögren's Syndrome: Positive in 50-70% of patients with primary Sjögren's
    • Mixed Connective Tissue Disease (MCTD): Frequently RF-positive
    • Cryoglobulinemia: Often RF-positive, particularly associated with hepatitis C
    • Chronic infections: Tuberculosis, hepatitis C, endocarditis may cause transient RF elevation
    • Malignancies: Lymphoma and other cancers occasionally associated with RF positivity
    • Extra-articular complications (in RF-positive RA):
    • Rheumatoid nodules: Subcutaneous nodules over pressure points (elbows, fingers)
    • Pulmonary involvement: Interstitial lung disease, pleural effusion, increased infection risk
    • Cardiovascular disease: Increased risk of atherosclerosis, myocardial infarction, pericarditis
    • Ocular manifestations: Scleritis, episcleritis, keratitis
    • Vasculitis: Systemic vasculitis affecting medium and small vessels
    • Felty syndrome: Splenomegaly, leukopenia, thrombocytopenia in RF+ RA patients
  • Follow-up Tests
    • Recommended additional tests based on RF results:
    • Anti-CCP antibodies (anti-cyclic citrullinated peptide): Increased specificity for RA; positive in 65-75% of RA patients; more specific than RF alone; helps diagnose seronegative RA
    • Antinuclear antibody (ANA): Screen for systemic autoimmune diseases like SLE and Sjögren's when RF positive
    • Erythrocyte sedimentation rate (ESR): Marker of systemic inflammation; correlates with disease activity
    • C-reactive protein (CRP): Acute phase reactant; better correlation with clinical activity than ESR in some patients
    • Complete blood count (CBC): Assess for anemia, leukopenia, thrombocytopenia; check for Felty syndrome
    • Comprehensive metabolic panel: Baseline assessment before starting immunosuppressive therapy
    • Liver function tests: Important before initiating DMARDs (disease-modifying antirheumatic drugs)
    • Anti-tissue transglutaminase (anti-tTG): Screen for celiac disease (associated with increased RA risk)
    • Imaging studies: X-rays of affected joints to assess for structural damage; MRI for early erosive changes
    • Monitoring frequency:
    • Initial diagnosis: RF testing combined with clinical assessment and imaging; repeat if borderline
    • Ongoing disease monitoring: Typically every 3-6 months initially; frequency may decrease with disease remission
    • Treatment response assessment: RF levels correlate variably with clinical response; ESR and CRP more reliable for short-term monitoring
    • During remission: May monitor annually or less frequently if clinically stable
    • Complementary tests for differential diagnosis:
    • Anti-double stranded DNA (anti-dsDNA): Specific for SLE when RF positive
    • Anti-Ro/SSA and Anti-La/SSB: Differentiates Sjögren's syndrome from other autoimmune diseases
    • Anti-mitochondrial antibodies (AMA): Screen for primary biliary cholangitis when RF positive
    • Hepatitis C antibody: If RF positive and risk factors present, screen for hepatitis C-associated cryoglobulinemia
  • Fasting Required?
    • Fasting requirement: NO - Fasting is not required for the rheumatoid factor test
    • The RF test measures antibodies in serum and is not affected by food or fluid intake
    • Patients may eat and drink normally before the blood draw
    • Medications:
    • No specific medications need to be discontinued for RF testing
    • Continue all current medications including DMARDs, corticosteroids, and biologics as prescribed
    • Immunosuppressive medications may affect RF levels but should not be discontinued without physician approval
    • Patient preparation requirements:
    • Arrive well-hydrated (improves venipuncture success)
    • Wear loose-fitting sleeves to facilitate blood draw from the arm
    • Inform phlebotomist of any history of difficult venipuncture or bleeding disorders
    • No special positioning required; can be drawn while seated or lying down
    • Specimen collection: 3-5 mL of serum in standard SST (serum separator tube) or gold-top tube
    • Results typically available within 24-48 hours
    • No restrictions on activity after blood draw; normal daily activities can be resumed immediately

How our test process works!

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