Rheumatoid Factor Test: Should We Rely on Rheumatoid Factor Levels?
The Rheumatoid factor test is not the only way to diagnose RA
It can be frustrating to read about the different ways that people interpret a Rheumatoid factor test. It seems there are still some doctors who think Rheumatoid factor levels are sufficient to diagnose Rheumatoid Arthritis. If you meet an RA specialist like that, I hope you will politely request your records and move on.
However, there is something more subtle that needs to be explored. Many rheumatologists treat RA patients based upon Rheumatoid factor levels. Some doctors rely on the Rheumatoid factor test to indicate either (1) disease severity or, (2) current disease state. Should they?
More than one Rheumatoid factor test
There is actually more than one type of Rheumatoid factor test (Rf). Additionally, there are several antibodies to measure. Some combination of antibodies may be tested including immunoglobulin A (IgA), IgG, or IgM. Some are considered better than others at identifying RA.
Rheumatoid Arthritis is a heterogeneous disease. Different antibodies are present in varying amounts in different patients who exhibit differing symptoms. There is not a one-size-fits-all test. “Different disease manifestations in RA may be associated not only with certain RF isotypes and RF isotype combinations but also with changes in lymphocyte subsets in the blood,” Journal of Rheumatology.
RA medication complicates interpretation of Rheumatoid factor levels
Different RA medications influence Rf test results to varying degrees. This may be true whether or not RA symptoms are diminished. There is even some evidence that over-the-counter NSAIDs (i.e.: Advil) can affect Rheumatoid factor (IgM).
One study examined “whether Rheumatoid factor isotypes and anti-cyclic citrullinated peptide (anti-CCP) antibodies are related to clinical response in patients with rheumatoid arthritis treated with tumour necrosis factor α (TNFα) inhibitors,” Annals of Rheumatic Diseases. “A significant reduction in the rheumatoid factor level was reported by all treatment groups after 1 year.” They found “significantly higher IgA rheumatoid factor levels were reported by the non-responder group” (those with refractory RA). “More interestingly, high pretreatment levels of IgA rheumatoid factor are associated with a poor clinical response to TNFα inhibitors.” How often is IgA the one that is tested?
Patients who respond well to TNF-blockers like Enbrel experience a greater decline in Rf levels than those with more resistant RA. However, “the decline in IgM-RF, but not ACPA, was associated with a decrease in CRP and ESR.” (ACPA is another name for anti-CCP, a more RA-specific antibody than the Rheumatoid factor. CRP is C-reactive protein and ESR is sedimentation rate.) But would the test result be the same if it did not test IgM?
A patient with severe RA who does not respond sufficiently to DMARDs could have a somewhat “improved” Rheumatoid factor, sed rate, and CRP. Does the patient or the doctor know which antibody is measured and what it may signify? The patient may be left with a high anti-CCP – and of course, her RA symptoms.
Treat the patient, not the Rheumatoid factor levels
There is no perfect Rheumatoid Arthritis test which can either diagnose or quantify RA. Even the markers of inflammation considered to be reliable such as the ESR, CRP, and various Rf’s may not always correlate with symptoms. The medications which do not cure RA or always bring reliable relief may “improve” the results of blood tests. RA may be uncontrolled and a patient may still be told that she is “better.”
Doctors who want to properly treat patients have only one option. When they examine patients, they must take note of symptoms that patients describe, trusting patients’ narratives more than blood test results. Patient input is the one indispensible component for a doctor to treat RA.
Postblog: Many Rheumatoid Arthritis patients are Rf negative altogether.
Recommended reading:
- Rheumatoid Arthritis Diagnosis
- 21 Things to Know About Finding a New Rheumatologist / Rheumatoid Arthritis Specialist
- Is there a blood test for Rheumatoid Arthritis? Part 1
- Rheumatoid Arthritis News: Actemra Approved
- The Four Courses of Rheumatoid Arthritis, part 1
my doctor never get the ra factor test done ….he says it will remain positive ever.
no need fr this again..
this means he doesnt consider levels also……
😕
I guess that’s good news: he’s treating you. Not just your labs. 😉
but he takes that esr , n liver enzymes,n hb n urine analysis everytime…. 🙁
i hv to get that prick..
That’s some good info and timely for me. I now have some specific questions to ask on Thursday since we are supposed to “discuss” new med options! Thanks Kelly!
Amy, Good luck. Let us know how it goes. Maybe ask him which Ig they test since you are at a teaching hospital. Someone recently commented that the IgA is more expensive so it’s not done as often.
What is the rate of false positives? or is there such a thing? Is it possible to have a positive Rheum Factor AND positive Anti-CCP and NOT have RA?
I don’t know why I’m doubting my diagnosis… I have all the classic symptoms. Just want to deny it, I suppose.
The odds of that are extremely low. The CCP is highly specific to RA. The combination of both postive is considered the closest thing to certainty you could get from labs. You would have to consider symptoms as well. If you had both tests postive and no symptoms at all, they’d probably tell you it was “latent” or that you should watch in case symptoms develop.
Btw: Yes, the Rf by itself can be postive w/no RA present. I think that’s usually due to another illness or RA that did not develop yet.
my orthopedist sent me to a rheumy because he thought I had something else wrong with me than mere carpal tunnel but the rheumy was too eager to get to the golf course (true!) that he looked at my hand x-rays (normal) and dismissed my RF (10x normal) as a false positive. My ortho persisted, after I had surgery for carpal tunnel and an entrapped middle finger tendon, and sent me to another rheumy who did more extensive bloodwork and gave me the RA dx.
I had wondered about this… my doc was doing a lot of bloodwork, but didn’t seem to be doing much with the results for a while.
My last visit answered the big question when he hmmmmmmed over recent lab results (RF and even ESR not terribly elevated despite being in the middle of a wicked flare) and declared not that I was “better”, but that my labs weren’t tracking my disease well. Got more aggressive with the MTX (I’m also on Simponi) based on my symptoms rather than the numbers.
Since I have to get stuck routinely for liver function and thyroid anyway, I don’t mind continuing to check the other stuff as additional data points (both for me personally and hopefully to help all of his patients if he has a better big-picture idea of how often labs don’t correlate with symptoms and so on).
Good docs are out there, I’m glad I found one.
Interesting. Almost makes me think of “reverse psychology” :heh: Glad he is treating “you.” That’s most important.
I would be interested in anyone who gets their cholesterol checked to know if it seems to track with your “flares” and “remissions” and what if anything you might be taking to control cholesterol and what rheumatoid meds you’re on.
Kelly, I’m sero-negative, but that hasn’t stopped the doctor from treating me for RA, which I clearly have. I’m glad he pays attention to symptoms! He also seems to be saying, where the meds and the diagnosis are concerned, that this is as much art as science. What works for one of us does not necessarily work for another.
Kelly,
I was tested from the start in December 2007 for RF and antiCCP antibody to confirm diagnosis. My RF was 268 with < 14 normal and Anti CCP 154 20-mild RA 40 moderate and over 60 severe.
I actually had 3 rheumies diagnosis of severe RA–unfortunately these high numbers especially CCP predict poor prognosis. I have a wonderful doctor who works with me and my symptoms and treats me not my labs—listening, discussing options, showing care, compassion, and optimism all the while. Having failed all the DMARDS due to side effects and enbrel, humira, orencia, rituxan- 2 courses within 4 months, kineret, and enbrel again I have just begun actemra this week and hope the different mechanism through the IL-6 cytokine pathway will be successful in slowing down my refractory RA. I am optimistic. Thanks Kelly for giving us this opportunity to share and support.
valerie
Dear Kelly,
You have put the point across very well. One should treat the RAer & not the lab reports. About 30- 35% RAers are Rf negative. Thus, the diagnosis of RA does not depend on RF positivity. Anti CCP is a much better option. But again, Anti CCP negative would not always mean absence of RA.
As Rachael has pointed out, there is no need to repeat the Rf test on follow up. It does keep fluctuating & has no correlation with the RA activity. Only quacks claim a cure of RA with a RF negative report on follow up!
I do like that “quack” statement. Of course I agree with you.
By the way: I’ve had some doctors tell me to my face that my Enbrel-reduced Rf and ESR indicate remission regardless of symptoms. Of course, I continued on until I found a much better doctor now.
Kelly,
This is really well put and I enjoyed reading it. I am very fortunate to have a rheumatologist who does not completely on Rheumatoid Factors. I was diagnosed when I was 15 with a negative RH factor, in the 5 years since then the factor has fluctuated a bit but for the most part staying negative. I am thankful that the rheumatologist believed more in what a 15 year old kid had to say (although the visible swelling was a good clue lol), than what a blood test showed, not alot of people will do that.
Kelly,
I just started going to a new Rheumey. I am also sero-negative. She did many blood test on me and I continue to be seronegative. But she goes by what you tell her and touching you. She said some of her really hard cases are people that are negative RH. Sometimes they are in a lot of pain too.This has been an interesting experience for me, I too thought that being negative RH , well the docs must have made a mistake?????I must not have it!!!! But this doctor is very proactive. So I realize I must really have it.
Thanks for all your hard work, Kelly
Stephanie, I’m glad the new rheum doc is so much better. I’m sorry people go thru so much due to being negative on one blood test – it really doesn’t mean that much – except that we need to “discover” better tests.
great answers to so many unknowns, THX
Something to investigate further and add to the research arsenal:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752456/pdf/v057p00063.pdf
iam 22 yr old ,and iam suffring from RA from last 5 yr…..now i diagonosis and my ra is 59….crp 40…..or esr 49……sholud i get relif is it possible………..and how…plz mail me or suggest me.iam very upset or depresed
I hope you do get relief. There are several treatments to try and if it does not help you enough, your dr should provide you with medicines to decrease the inflammation and the pain. Please tell the doctors how you feel & do not let yourself suffer more than necessary.
All I know is that each doctor I see says the opposite of what the previous one did. One says RA, the next says Fibromyalgia… I used to know all of my numbers, but now, I am having a hard time remembering what numbers to even remember. I haven’t a clue what to do next….
I just had another frustrating appointment with a new rheumatologist. I swear she is just after the money & a pill pusher. She didn’t listen to me. I have every test known to man and the only thing wrong with me according to the tests is I have RA. I have only had the RF test & CBC. I have managed my RA with Celebrex for year but now with dibilitating stress it has gotten worse. She told me that wasn’t possible but I know my body. When Obama really stressed my joints swell & cause pain. I now have digestive track/abdominal issues. My primary & I think it may be from the RA. She won’t even talk to me about it. Very frustrated. Are there actually rheumatologist that treat the person, the symptoms . & the body… Think outside the box?
My test for RA was negative and unfortunately the first Rhematologist that I saw read the results and sent me to a Neurologist even though both of my ankles were swollen, painful, and stiff. After months of the symptoms getting worse, I woke up one day and literally could not make my ankles move, I could not move my neck to the left, right, or back and my jaw was locked. I saw 5 specialists in 8 months, had every blood test ran and thought I was crazy and dying! I finally saw a new family doctor that said even though the RA test came back negative, she urged me to get a 2nd opinion from a different Rheumy and I did. After she examined me, she was sure I had RA. She gave me a round of steroids (which gave me my life back within 24 hrs) and put me on Methotrexate. I freaked out for the 1st 2 weeks and was too terrified to take it after reading reviews and I could not get the “Chemo therapy drug” out of my head. As the steroids wore off and the symptoms returned, I prayed and took my first dose. She put me on 15 mg, but I decided to try and only take 7.5 and really change my diet. Tonight will be my 3rd week on it and so far, no negative side effects. I read that the Methotrexate should take effect in 4-6 weeks. If I still have symptoms after that, I plan on adding one more pill for a month and so on. My goal is to try and get relief from the least amount of Methotrexate as possible. I am still in some what of shock/denial/depression over having this. I am only 39 and I keep thinking why, how,…I am really trying to stay positive and accept it, but it’s hard when you feel like this.
I am one of those lucky ones that is sero-negative. My CRP is always < .05. and RF is <20. The only markers that seem to indicate inflammation in my blood are my lymphocytes, neutrophils and ferratin (usually very high).
I believe that something like 40% of those diagnosed are this way. My doc had to do an MRI of my "bad" wrist to find corrosive damage to confirm the diagnosis over 2 years ago.
Are there others out there like me? My doc put me on a super strict anti-inflammatory diet. I don't have the inflammation show up in my blood tests but I do certainly feel it some days! Will diet and meds do anything since I am atypical? I'm currently on Methotrexate and the highest dosage of Remicaide. We just increased it for my next infusion since I am still in a lot of pain and have a LOT of morning stiffness. My mom was like this too and she was also medication resistant. But she was diagnosed about 20 years ago and the science has advanced greatly since then. I read a lot about making sure to have your docs test for all things besides just the RF and CRP but I don't seem to find a lot about folks like me that are sero-negative.
This is a great site and I am glad I found it!
Hi, I’m 30 y/o. I finally saw a regular dr for my symptoms: fatigued all day but difficulty falling asleep at night, not feeling rejuvenated after a long sleep, I’d just experienced a couple days where it was extremely difficult to stand or walk due to pain in the pelvic area, hair loss, brittle hair, weight gain, sensitivity to temps, moody, difficulty concentrating, menorrhagia, acne and strong ‘hormonal’ like changes around my periods.
My dr did a wide range of blood tests cbc, cholesterol, thyroid panel etc. Thyroid was normal, 1:320 ANA homogenous, and Vit D deficient. My wbc count and T3 free were on the high end of normal. She discussed my joint problems (I have flat feet,TMJ,lower back and carpal tunnel pain since my early 20s, my joints will pop head to toe), I had pain with movement but normal range of motion. Aleve is the only thing I have found so far that REALLY helps me deal with the pain of getting around during the day. The dr suspected RA or Lupus and referred me to a Rheumy. The rheumy dismissed the loud joint popping as nothing of any concern?!?
The rheumy suggested I have fibromyalgia and that I might have thyroid antibodies (my mother has graves disease), and that I might have more than 1 problem. She ordered blood tests for ANA, SED rate, C reactive protein, CCP, RF-IGM, immunoassay IgA IgG. I’m worried that she hasn’t taken RA or Lupus into serious consideration and that the tests seem kind of skimpy. What if something is missed! There are only 2 rheumy offices in my area. I just don’t want to go X amount of years with a blase diagnosis and turns out I should have been tested for RF-IGA too to catch a sign of RA or something.
I feel like I can trust my regular dr, she was VERY thorough and very straightforward with me. She caught things that I was dismissing and so far has seemed to make the right calls. This rheumy is giving me bad vibes, I felt rushed and while she listened to my symptoms she didn’t STOP to listen and let me explain ALL my symptoms. I would try to explain and she’d say “well fibromyalgia can do that” or “thyroid autoimmune can do that too” . For example I said “I have trouble getting out of bed in the morning, everything hurts especially my back and my feet. The only relief is a HOT shower. I cannot physically start my day without it.” And she interrupted me after the word morning and asked if I was stiff and when I said “well….” and she said “cause fibro can do that too, but if you were stiff I’d think more of a joint problem”. Really?? I’m telling you my joints hurt ache and pop and it doesn’t feel better until I have a hot shower and you think it can’t be my joints if I don’t specifically say I feel stiff?? =(
I am one of those folks who tested with a negative rheumatoid factor and was subsequently misdiagnosed. As a consequence of that error, once the correct diagnosis was made by my current (and wonderful) rheumatologist I already had a lot of joint damage. Since then, treating my case has been like chasing a train going downhill! I only wish the prior doc had had a better understanding of this disease and how it’s diagnosed!
I was diagnosed with RA in 2004 by my pcp. He immediately put me on Enbrel which I took up until last year. Then my new pcp told me all of the horrible side effects it could cause. So I stopped taking it. I didn’t notice any obvious pros or cons to taking the medication. I haven’t noticed any issues since I have stopped. But my new pcp seems to think that maybe I don’t have RA because it has been 12 years and my hands are not all twisted up. He thinks that it has been a false positive all of these years. I have only had my Rheumatoid factor done maybe 4 times and recently had a Rheumatoid Latex? done…what are the chanced of false positives for all of these years and not being all crippled up after 12 years??? Do I have another disease maybe???
The so-called “rheumatoid factor” test can be positive in people who don’t hard rheumatoid disease. Can you get an anti-CCP test? That is more specific to RA / RD (very few “false positives”). Also, try to find a doctor who uses ultrasound to evaluate joints and see him/her when your joints are bothering you (“flare”).
Twisted joints are usually later stage disease.
I have had Fibromyalgia for 25 years. Over the last year I have had swelling and great pain in my wrists. First the Right, then months later in the Left, then months later in the Right again. I was told to see a Rheumatologist. My RF test’s were IgM-135, IgG-23, IgA-48 with CCP-58, SED-5mm.
No issues on X-rays. I’m waiting for test results to give us a number (cant remember what the test it called). My question is could I have issues in my lungs and heart already? Could it have started elsewhere, not in the joints? Scared – Fibro is flareing like crazy!!
Yes it’s definitely possible to start elsewhere. If you’ve been diagnosed as FMS for a long time, the RD could likely have been simmering many years – just without enough conspicuous swelling to be diagnosed as RA / RD.
This might help –
https://www.rawarrior.com/what-is-the-first-symptom-of-rheumatoid-arthritis/
As always, read the comments pages for more info.
Kelly
Thank you for this! My story supports too.
I was diagnosed with “young osteoarthritis” which in fairness my mother had too, and then last year requested and got a new Rheum consult when I had involvement of a bunch of new joints simultaneously. The labs were negative except my ESR (I do have IgG deficiency). My wonderful Rheumatologist diagnosed seronegative RA. Now one year later my RF IgA turned positive (and we’ve had a really hard time getting control, go figure). The others are still negative. She has been treating me based on symptoms.
Hi, my Dr is sending me again for blood work. I had blood work done a year and a half ago and RF was negative, but my pain in my knees and ankles and hips is bad and it’s effecting my everyday life. He has been prescribing Celebrex which does take the edge off if I take it regularly twice a day. The problem is the Celebrex kills my stomach and then I have to take something for heartburn and it still is an issue. I am going again for blood tests tomorrow. If I take pain meds or anti inflammatories does that change the RF in the test? I wasn’t sure and so today I have only taken a couple Tylenol. But I am laying in bed with crazy pain. I wish I knew if the meds altered the test. I wish I would just get a positive RF test so that I can get the right help for my pain!
Jeanine,
Is he ordering the test ro decide whether to treat you?
Have you had an anti CCP test? Many people with RA are RF negative, at least early on.
To your question, i don’t think anti inflammatories affect RF results. But they might reduce inflammation and therefore other tests like ESR or CRP could ve influenced. I’d be surprised if the doc hasn’t ordered those and the anti CCP at the same time. They are part of a basic rheum panel.
Good luck. I’ve been there.
Hi, I just get so frustrated. I have had RA for about 10 years. Whenever I flare badly, my biologic is always changed, but when the dr runs the usual tests on me, it shows no active RA. So then it is passed off as Fibro. Its no wonder that RA and Fibro run hand in hand. I just feel it is a cop out. Even when my hands were so swollen, my dr said it wasnt the right kind of swelling for RA. Is that possible? Please reply with any thought you may have on this or if this happens to you. Thank you for reading.
Thank You so much for you’re website! I am scheduled with a rheumatologist soon and will make sure all these labs are done. I am 42 and in the past year have needed cortisone shots in both knees and when I questioned the orthopedic about RA he quickly disregarded my concerns and made me feel like I was imagining these symptoms. I have been on long term treatment with Minocycline for Acne and every “flair up” I have had has been while I was off the medication. I have now been off the Minocycline for 2 or 3 months and now have joint swelling, redness, stiffness in both hands and wrists. My grandfather had RA so I am praying I do not have it but if I do, I would like to know early before damage starts! Thank You for helping those dealing with possible RA symptoms not feel like they are a hypochondriac!