Rheumatology Advance Access published online on September 1, 2007
Rheumatology, doi:10.1093/rheumatology/kem210
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Time to abandon the rheumatoid factor? Is it not time to rename it?
Department of Rheumatology, Portsmouth Hospitals Trust, Southwick Road, Cosham, Portsmouth PO6 3LY, UK
Correspondence to:
Ragai Shaban, Department of Rheumatology, Portsmouth Hospitals Trust, Southwick Road, Cosham, Portsmouth PO6 3LY, UK. E-mail: Ragai.Shaban{at}porthosp.nhs.uk
SIR, We read Professor Symmons editorial [1] with interest. We agree with her conclusions and recommendations and would suggest another angle to the debate regarding the rheumatoid factor (RF).
Pike et al. [2] first suggested the name RF in 1949. In his original paper he states ‘the property of agglutinating sensitised sheep cells to a marked degree appears to be almost exclusively with the serum in rheumatoid arthritis. The phenomenon is due to a factor, which is present in the serum globulins and its effect is diminished on storage for a considerable period. Until this factor is more completely characterised, it may be conveniently termed the rheumatoid factor.’
We conducted a small study to assess the effect of the term RF on primary care physicians (PCPs), who are the main users of the test for RF, and on patients who had this test (the study was part of an MSc in Rheumatology and had ethical committee approval). We thought the results were interesting. It showed that 56.3% of PCP thought that patients assume that they have rheumatoid arthritis (RA), when informed that they had a positive RF. Also, 51.4% of PCPs thought that changing the term RF would cause less anxiety in patients and 72.4% thought that it would also make the explanation of the test results to patients easier.
The majority of patients (73.7%) who were told that had a positive RF assumed that they had RA. Despite explanation by their PCP, 63.6% stated that having a positive RF caused them anxiety and concern.
In the group of patients who were told that they did not have a positive RF, 15 out of 16 (93.8%) assumed that they did not have RA.
We concluded that the term RF appears to lead to over-reliance on its significance in making or excluding the diagnosis of RA. It seems to imply that its presence or absence confirms with the presence or absence of RA, at least in the mind of most patients even after explanation. It gives unjustified anxiety, fear or even reassurance.
Now the nature of this auto-antibody is fully characterized, perhaps it is time to update Pike's convenient term to a more scientifically accurate and less anxiety-provoking term.
We suggest a competition for renaming the RF should be launched.
The authors have declared no conflicts of interest.
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- Symmons DP. Classification criteria for rheumatoid arthritis—time to abandon rheumatoid factor. Rheumatology (2007) 46:725–6.
[Free Full Text] - Pike RM, Sulkin SE, Coggeshall HC. Serological reaction in rheumatoid arthritis. II Concerning the nature of the factor in rheumatoid arthritis serum responsible for increased agglutination of the sensitised sheep erythrocytes. J Immunol (1949) 63:448–63.
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