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Abstract
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetric pattern. Constitutional symptoms, including fatigue, malaise, and morning stiffness, are common. RA has an unknown cause, although an environmental, genetic, hormonal, immunologic, and infectious factors may play significant roles and the socioeconomic, psychological, and lifestyle factors may influence disease outcome. RA affects all populations, although few groups have much higher prevalence rates. In (RA) although the articular structures are the primary sites, other tissues are also affected such as the skin, heart, lungs, and eyes. RA causes joint destruction and thus often leads to considerable morbidity ,disability and mortality.
Rheumatoid factors (RF) are autoantibodies directed against the Fc portion of IgG. They are found in 75 to 80 percent of (RA) patients at some time during the course of their disease. High titer IgM-RF is relatively specific for the diagnosis of (RA) in the context of a chronic polyarthritis, and remains the sole serologic criterion widely used in the diagnosis of (RA). It has little predictive value in the general population, however, since the overall disease prevalence is relatively low. RF also occur in other diseases such as some connective tissue diseases (SLE and primary Sjögren’s syndrome).In addition, (RF) may be measured in patients with certain infections, such as malaria and rubella, and following vaccinations.
Rheumatoid factors may have some prognostic value with regard to disease manifestations, activity, and the severity of joint erosions. Seropositive (RA) is often associated with more aggressive joint disease, and is more commonly complicated by extraarticular manifestations than seronegative (RA) for examples:Rheumatoid nodules and vasculitis occur almost exclusively in seropositive patients and the radiographic progression may be more frequent among patients with a positive (RF) at initial evaluation . It has also been proposed that the rate of formation of new erosions among seropositive patients correlates with the RF titer. The presence of RF may antedate the clinical development of (RA).
Immunoglobulin (A) Rheumatoid Factor (IgA-RF) is one of the Rheumatoid Factor isotypes which are (IgA-RF), (IgM-RF), (IgG-RF) and (IgE-RF).There are two subclasses of the immunoglobulin (A) Rheumatoid Factor; IgA1 RF and IgA2 RF. It was reported in previous studies that the presence of (IgA RF) was found to be associated with a rapid progressive course, increased RA activity, onset of extra-articular manifestations (especially systemic Rheumatoid vasculitis), high (IgM-RF) titres, circulating immune complexes, cryoglobulins, and C-reactive protein levels.
The purpose of this study was to determine the correlation between immunoglobulin (A) rheumatoid factor (IgA-RF) and measures of disease activity and severity in patients with rheumatoid arthritis (RA).
Forty six (46) adult Rheumatoid Arthritis patients, fulfilling the American Rheumatism Association (ARA) 1987 revised criteria for the classification of Rheumatoid Arthritis from the Rheumatology outpatient clinic of Nashville General Hospital, Rheumatology clinic in Vanderbilt Hospital,and Sinus and Allergy Center constituted the total number of patients in this study.
Twenty three (23) of them were sero-positive for Immunoglobulin (A) rheumatoid factor (IgA RF) positive, represented the study group.
The remaining number (23) patients were sero-negative for Immunoglobulin (A) rheumatoid factor (IgA RF) negative, represented the control group after matching for age and sex with the study group.
Full history, general examination,musculoskeletal examination, HAQ,Fuchs Joint count,Ritchie index,Mallaya and Mace activity Index, Steinbrocker`s Radiological evaluation and some laboratory investigations including ESR,CBC,CRP,C1q,ELISA forIgA, IgG, IgM were done for all studied patients
The relationships between (IgA-RF) and HAQ (1- 10), pain, stiffness, patient satisfaction,global assessment fatigue radiographic staging, complement component (C1q) and other individual clinical and laboratory parameters such as tender joint count, morning stiffness, hemoglobin (Hb) level, and erythrocyte sedimentation rate (ESR) was not significant.
The relationship between (IgA-RF) and other rheumatoid factors (IgM-RF) and (IgG-RF) was significant.
Based on the results of this study,the IgA-RF positivity has no prognostic value,and requisting ELISA test to detect IgA-RF is not a must in following up Rheumatoid arthritis (RA) pa
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