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  1. Fulltext Anti-cyclic citrullinated peptide antibody is highly associated with rheumatoid factor and radiological defects in rheumatoid arthritis patients
    Sulaiman FN, Wong KK, Ahmad WAW, Ghazali WSW
    Medicine (Baltimore), 2019 Mar;98(12):e14945.
    PMID: 30896663 DOI: 10.1097/MD.0000000000014945
    Rheumatoid arthritis (RA) is a chronic debilitating inflammatory disease affecting mainly the joint, surrounding tissue and other extra-articular structures in the body. RA can lead to destruction of bone and cartilage which may cause severe disability and it is characterized by the presence of serum rheumatoid factor (RF). The anti-cyclic citrullinate peptide (anti-CCP) antibody is another serum biomarker used in RA diagnosis with higher sensitivity and specificity.In this cross-sectional study with retrospective record review, 159 established RA patients from Hospital Universiti Sains Malaysia (HUSM) were recruited. Enzyme-linked immunosorbent assays (ELISAs) for serum RF and anti-CCP were performed. Our goal was to evaluate the significance of anti-CCP antibody in predicting the disease activity and progression in terms of radiological and extra-articular manifestations upon diagnosis.Of the 159 RA patients included in this study, mean age was 48.3 years old and majority (n = 134; 84.3%) were female. A total of 83 (52.2%) and 99 (62.3%) patients had anti-CCP antibody and RF, respectively. Mean Disease Activity Score-28 for Rheumatoid Arthritis with erythrocyte sedimentation rate (ESR) (DAS28-ESR) score for all patients was 4.74 (medium and high disease activity). Fifty-eight (36.5%) patients had radiological defects and 49 (30.8%) patients had extra-articular involvement manifested by rheumatoid nodule, pulmonary involvement, and anemia.In terms of anti-CCP antibody association with clinical and laboratory parameters, a significant co-occurrence of RF and anti-CCP antibody (P = .002) was observed. Anti-CCP antibody was significantly associated with radiological defects in which majority of patients with such defects (n = 40/58; 68.9%) were positive for anti-CCP antibody (P = .001). However, there was no significant difference between mean and classes of disease activity score and extra-articular manifestations between different anti-CCP antibody groups. In addition, extra-articular manifestations were not associated with high disease activity upon RA diagnosisThere was a significant association between anti-CCP antibody positivity and positive RF. Radiological defects were the sole clinical parameter significantly associated with anti-CCP antibody positivity, indicating that patients positive for anti-CCP antibody should be routinely monitored for radiological defects and their onset.
    Matched MeSH terms: Rheumatoid Factor/blood*; Rheumatoid Factor/immunology
  2. Rheumatoid arthritis: case review from MOH collaborative rheumatology centers in Malaysia. [Abstract]
    Sulaiman W, Othman M, Mokhtar AM, Rosman A, Ong SG, Soo IS, et al.
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A54-A55.
    DOI: 10.1111/j.1479-8077.2006.00199_24.x
    Objective: To determine the number of RA cases and to evaluate the demographic patterns in all 4 Rheumatology Referral Centers under the Ministry of Health Malaysia. Materials and methods: One thousand and eighty-four rheumatoid arthritis patients from all 4 centers i.e. Hospital Selayang, Putra Jaya, Seremban and Taiping which are situated in the west coast of West Malaysia, using rheumatoid arthritis database comprising of basic clinical and patient questionnaire, until the end of year 2004 were analysed. Results: At the time of documentation, 88.6% were female at all range of ages especially between age of 25 and 54 years (77.6%) with female to male ratio 8 :1. 52.1% were housewives. Mean age of onset of RA was 49.6 ± 11.8 SD with female 49.3 ± 11.7 SD and male 52.0 ± 12.0 SD (p < 0.05). Indian was the predominant ethnic group (54.5%), followed by Malay (31.4%), Chinese (11.6%) and others (27%). Majority had their education up to secondary level (50.8%), followed by primary (32.6%), and tertiary (6.3%) levels while 10.3% of cases had not received any formal education in their lives. 74.4% were seropositive and 87.3% fulfilled at least 4 out of 7 American College of Rheumatology (ACR) revised criteria for rheumatoid arthritis. 74% were diagnosed RA within 2 years after the onset of arthritis. Seropositivity was not significantly related to gender. Positive rheumatoid factor was dominated by Indian followed by Malay and Chinese. 83.3% were married. 23.3% female and 33.9% male between age group 25-54 were employed. 7.4% had achieved their retirement at time of entry whilst 8.9% were unemployed. Employment status was statistically significant across gender (p < 0.001). The cases differed between rheumatology centers as well as individual practices. Conclusion: There are increasing numbers of RA cases in Malaysia. Results from this study did not reflect the true prevalence of RA in Malaysia. Hence, a larger and more comprehensive database on RA with collaboration of all Government and Private Hospitals in the whole nation will provide better information about the patient case mix in different healthcare settings, treatment practice as well as disease complications. The implementation of rheumatology centers with better regional cooperation, will lead to better treatment and outcome in terms of identification of early as well as established RA cases. Early referral to the centers will be made possible for proper treatment institution and rehabilitation. Hence, improve quality of life including socio-economic status especially among those within the productive age.
    Matched MeSH terms: Rheumatoid Factor
  3. A survey of the rheumatoid factor using the sheep cell agglutination test
    Lim TW, Leong WW
    Med J Malaya, 1967 Dec;22(2):110-4.
    PMID: 4231975
    Matched MeSH terms: Rheumatoid Factor/analysis*
  4. Diagnostic performance of anti-RA33 antibody as a serological marker for rheumatoid arthritis
    Syed Mohamed Suhail SM, Nur Atiqah I, Nur Salimi Zakirah ZA, Lailatul Syazwani Z, Batis WW, Md Monoto EM, et al.
    Malays J Pathol, 2019 Dec;41(3):259-265.
    PMID: 31901910
    INTRODUCTION: Rheumatoid arthritis is diagnosed based on the 2010 Rheumatoid Arthritis Classification Criteria whereby rheumatoid factor and anti-citrullinated protein antibody are the serological markers included in these criteria. Anti-RA33 antibody has the potential to provide additional diagnostic value in rheumatoid arthritis. The aim of this study is to determine the diagnostic performance of anti-RA33 antibody as a serological marker for rheumatoid arthritis.

    MATERIAL AND METHODS: Thirtyfour patients with rheumatoid arthritis and 34 non-rheumatoid arthritis individuals were included in this cross-sectional study. Anti-RA33 antibody and rheumatoid factor were performed on all samples.

    RESULTS: The sensitivity, specificity, positive and negative predictive value for anti-RA33 antibody and rheumatoid factor were 41.1%, 97.1%, 93.3%, 62.3% and 64.7%, 79.4%, 75.9%, 69.2% respectively. The overall sensitivity and specificity if either anti-RA33 antibody or rheumatoid factor are positive were 79.4% and 76.47% respectively.

    CONCLUSION: Anti-RA33 antibody showed good specificity and positive predictive value and could be considered as a potential serological marker for rheumatoid arthritis diagnosis.

    Matched MeSH terms: Rheumatoid Factor/blood*
  5. Elevated serum rheumatoid factor, anti-citrullinated protein antibodies and active rheumatoid arthritis disease are not associated with chronic periodontitis
    Che Rahim MJ, Wan Mohamad WM, Saddki N, Taib H, Wan Abhamid WZ, Wong KK, et al.
    Malays J Pathol, 2019 Dec;41(3):267-272.
    PMID: 31901911
    INTRODUCTION: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of the joints with the involvement of other systems. Previous studies have demonstrated its association with chronic periodontitis (CP), a chronic inflammatory disease of tooth-supporting tissues. Positive rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) in RA patients have been found to be associated with CP. The aim of this study is to determine the prevalence of CP in RA patients, and to investigate the association of ACPA, RF status and RA disease activity with CP and non-CP RA patients.

    MATERIALS AND METHODS: A comparative cross-sectional study involving 98 RA patients was conducted at Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia. Clinical oral examination was carried out to determine the CP status of RA patients. RF, ACPA and erythrocyte sedimentation rate (ESR) were measured, and the 28-joint Disease Activity Score (DAS-28) was assessed.

    RESULTS: Forty-five patients (45.9%) were found to have CP (95% CI: 0.36-0.56). No significant difference was observed in the prevalence of positive RF (p=0.989) or ACPA (p=0.431) in CP and non-CP RA patients. There was also no significant association between active RA disease (DAS-28 score ≥3.2) and RF positivity in CP (p=0.927) and non-CP (p=0.431) RA patients as well as ACPA positivity in CP (p=0.780) and non-CP (p=0.611) RA patients.

    CONCLUSION: In our cohort of RA patients, we did not find significant associations between elevated RF, ACPA, or active RA disease with the presence of CP. There were also no significant associations between elevated RF or ACPA with active RA disease.

    Matched MeSH terms: Rheumatoid Factor/blood*
  6. Fulltext Anti-carbamylated protein antibodies in rheumatoid arthritis patients and their association with rheumatoid factor
    Othman MA, Ghazali WSW, Hamid WZWA, Wong KK, Yahya NK
    Saudi Med J, 2017 Sep;38(9):934-941.
    PMID: 28889152 DOI: 10.15537/smj.2017.9.20841
    OBJECTIVES: To evaluate levels of anti-carbamylated protein (anti-CarP) antibodies in rheumatoid arthritis (RA) patients and to determine their association with serological parameters and disease activity. Methods: A cross-sectional study involving 105 multiethnic RA patients (48 rheumatoid factor [RF]-positive and 57 RF-negative patients) was conducted at Hospital Universiti Sains Malaysia, Kelantan, Malaysia, from January 2015 to February 2016. Fifty healthy controls (HCs) were included. C-reactive protein (CRP), RF, anti-cyclic citrullinated peptide (anti-CCP) and anti-CarP antibodies were measured. A health assessment questionnaire (HAQ) was administered to the study participants and 28-joint Disease Activity Score (DAS28) were obtained. Results: The level of anti-CarP antibodies was significantly increased in the RA patients compared with HCs (p=0.042). The presence of anti-CarP antibodies was significantly associated with RF (p=0.019) and the HAQ (p=0.010). A significant association between the presence of anti-CarP antibodies and the DAS28 was not found (p=0.632). Conclusion: Our study provides further evidence that the level of anti-CarP antibodies is significantly elevated in RA patients.

    Study site: Rheumatology clinic, Hospital Universiti Sains Malaysia
    Matched MeSH terms: Rheumatoid Factor/immunology*
  7. Fulltext The prevalence of rheumatoid factor isotypes and anti-cyclic citrullinated peptides in Malaysian rheumatoid arthritis patients
    Gomez EL, Gun SC, Somnath SD, D'Souza B, Lim AL, Chinna K, et al.
    Int J Rheum Dis, 2011 Feb;14(1):12-7.
    PMID: 21303477 DOI: 10.1111/j.1756-185X.2010.01573.x
    AIM: The purpose of this study is to compare the prevalence of rheumatoid factor (RF) isotypes and second generation anti-cyclic citrullinated peptides (anti-CCP) in Malaysian rheumatoid arthritis (RA) patients.
    METHODS: In this cross-sectional study, 147 established RA patients from three ethnic groups were recruited from a major rheumatology clinic in Malaysia. Enzyme-linked immunosorbent assays (ELISA) for serum RF isotypes IgA, IgG and IgM as well as second-generation anti-CCP were performed and the prevalence of each auto-antibody was compared in the three ethnic groups.
    RESULTS: The anti-CCP was the most prevalent auto-antibody in each of the ethnic groups, followed closely by RF IgM and RF IgG. Rheumatoid factor IgA was the least prevalent across all three ethnic groups. The anti-CCP-RF IgM combination provided the best test sensitivity. Seroprevalence of anti-CCP was strongly associated with the presence of each of the RF isotypes. The seroprevalence of RF and anti-CCP did not increase or decrease with advancing age, age at onset and disease duration.
    CONCLUSION: When used alone, anti-CCP provides a diagnostic advantage over RF IgM on the basis of test sensitivity. Considering the high cost of the anti-CCP assay, step-wise serum testing with IgM RF followed by anti-CCP may provide a more economically sensible option to optimize test sensitivity for RA.
    Study site: Rheumatology clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Rheumatoid Factor/blood; Rheumatoid Factor/immunology*
  8. Anti-cyclic citrullinated peptide autoantibodies (anti-CCP) in Malaysian patients with rheumatoid arthritis. [Abstract]
    Yuslina MY, Shahnaz M, Too CL, Hussein H, Wahinuddin S, Eashwary M, et al.
    APLAR Journal of Rheumatology, 2006;9 Suppl 1:A187-A188.
    Background: Anti-cyclic citrullinated peptide autoantibodies (anti-CCP) is a new serological test for the diagnosis of rheumatoid arthritis (RA). It is an enzyme immunoassay (EIA) for the detection of antibodies directed toward citrullinated peptides. Studies show this test has an improved diagnostic value compared to rheumatoid factor (RF). Objective: To determine the sensitivity and specificity of anti-CCP in patients with rheumatoid arthritis and other rheumatic diseases. Method: 227 serum samples for rheumatology clinics (Putrajaya, Taiping, and Ipoh Hospital) were tested for the presence of anti-CCP and rheumatoid factor (RF). These included 171 patients diagnosed with RA and 56 from other rheumatic diseases. Patient demographic data, clinical diagnosis, radiographic information and other laboratory data were obtained from the patients' clinical notes. Results: Anti-CCP antibodies were detected in 76.6% (131/171) patients with RA and 17.9% (10/56) patients with other arthritis. The sensitivity and specificity of anti-CCP reactivity at the optimal cut off values were 66.1% and 87.5% respectively. The sensitivity of anti-CCP was higher than that for RF (41.8%). However, the presence of either anti-CCP or RF improved the sensitivity to 76.2%. Conclusion: The detection of anti-CCP alone maybe useful in the diagnosis of RA. However, when used concomitantly with RF, it can improve the diagnostic ability significantly.
    Matched MeSH terms: Rheumatoid Factor
  9. Fulltext Early referral of newly diagnosed rheumatoid arthritis
    Das Gupta E, Gun SC, Abdul Rahman YR
    Family Physician, 2003;12(1):16-8.
    1. Revised ARA criteria (1987) the diagnosis of RA requires presence of at least 4 of the following 7 features: 1) morning stiffness> 1 hour 2) swelling of 2 or more joints (of 6 weeks duration) 3) symmetrical joint involvement 4) arthritis of more than 1 hand joints (of at least 6 weeks duration) 5) positive rheumatoid factor, 6) presence of rheumatoid nodule 7) X-ray changes. 2. Use of DMARD should start early, along with pain control by non steroidal anti inflammatory drugs (NSAID) 3. Early referral to rheumatologists is the current recommendation 4. Indications for early referral include: i. Early morning stiffness (EMS) of 30 mins ;- ii. Metatarsophalangeal (MTP) / metacarpophalageal (Mep) involvement. iii. 2 or more swollen joints.
    Matched MeSH terms: Rheumatoid Factor
  10. Fulltext Ethnic differences in the prognostic utility of rheumatoid factor isotypes and anticyclic citrullinated peptides in rheumatoid arthritis patients: a cross-sectional study
    Gomez EL, Gun SC, Somanath SD, Chinna K, Radhakrishnan AK
    Mod Rheumatol, 2013 Jul;23(4):716-21.
    PMID: 22854883 DOI: 10.1007/s10165-012-0718-6
    OBJECTIVES: The prognostic significance of rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) in rheumatoid arthritis (RA) remains contentious due to the conflicting lines of evidence. This study aims to determine the association between RF isotypes and anti-CCP with disease severity in RA patients from three ethnic groups.
    METHODS: A total of 147 RA patients from three different ethnic groups (Malays, Chinese, and Indians) who fulfilled the 1987 American College of Rheumatology (ACR) revised criteria for RA were recruited into this study. The seroprevalence of RF isotypes immunoglobulin (Ig)A, IgG, and IgM, as well as anti-CCP was determined using commercial enzyme-linked immunosorbent assay (ELISA) kits. Multinomial regression analysis was performed to assess the independent effects of autoantibody status on the development of deforming and erosive RA and the presence of extra-articular manifestations (EAM).
    RESULTS: In Chinese patients, we found a significant association (p < 0.05) between IgG RF and anti-CCP and the presence of erosive disease, as well as IgM RF and IgG RF with the presence of joint deformities. In Indian patients, IgM RF was associated with deforming disease, whereas none of the antibodies were associated with disease severity in Malay patients. Multinomial regression analysis revealed that IgG RF was the most important predictor variable for erosive disease in Chinese patients, and IgM RF the only predictor variable associated with deforming disease in both Chinese and Indian RA patients.
    CONCLUSIONS: There is variability in the phenotypic association of RF isotypes and anti-CCP in relation to disease severity of RA in the three ethnic groups. RF, in particular, IgG and IgM, may be better prognosticators of severe disease in Chinese and Indian patients.
    Matched MeSH terms: Rheumatoid Factor/immunology*
  11. Fulltext Shared epitope alleles remain a risk factor for anti-citrullinated proteins antibody (ACPA)--positive rheumatoid arthritis in three Asian ethnic groups
    Too CL, Padyukov L, Dhaliwal JS, Lundström E, Yahya A, Muhamad NA, et al.
    PLoS One, 2011;6(6):e21069.
    PMID: 21698259 DOI: 10.1371/journal.pone.0021069
    BACKGROUND: To investigate the associations between HLA-DRB1 shared epitope (SE) alleles and rheumatoid arthritis in subsets of rheumatoid arthritis defined by autoantibodies in three Asian populations from Malaysia.
    METHODS: 1,079 rheumatoid arthritis patients and 1,470 healthy controls were included in the study. Levels of antibodies to citrullinated proteins (ACPA) and rheumatoid factors were assessed and the PCR-SSO method was used for HLA-DRB1 genotyping.
    RESULTS: The proportion of ACPA positivity among Malay, Chinese and Indian rheumatoid arthritis patients were 62.9%, 65.2% and 68.6%, respectively. An increased frequency of SE alleles was observed in ACPA-positive rheumatoid arthritis among the three Asian ethnic groups. HLA-DRB1*10 was highly associated with rheumatoid arthritis susceptibility in these Asian populations. HLA-DRB1*0405 was significantly associated with susceptibility to rheumatoid arthritis in Malays and Chinese, but not in Indians. HLA-DRB1*01 did not show any independent effect as a risk factor for rheumatoid arthritis in this study and HLA-DRB1*1202 was protective in Malays and Chinese. There was no association between SE alleles and ACPA- negative rheumatoid arthritis in any of the three Asian ethnic groups.
    CONCLUSION: The HLA-DRB1 SE alleles increase the risk of ACPA-positive rheumatoid arthritis in all three Asian populations from Malaysia.
    Matched MeSH terms: Rheumatoid Factor/immunology
  12. Fulltext IgA rheumatoid factor as a serological predictor of poor response to tumour necrosis factor α inhibitors in rheumatoid arthritis
    Sakthiswary R, Shaharir SS, Mohd Said MS, Asrul AW, Shahril NS
    Int J Rheum Dis, 2014 Nov;17(8):872-7.
    PMID: 25292482 DOI: 10.1111/1756-185X.12443
    AIM: The main objective of this study is to elucidate the role of immunoglobulin A (IgA) rheumatoid factor (RF) in predicting the clinical response to tumour necrosis factor α inhibitors (TNFi) among patients with rheumatoid arthritis (RA).
    METHOD: We recruited all patients with RA who were ever on TNFi for a minimum duration of 3 months at our centre. Based on the European League Against Rheumatism response criteria, subjects were further divided into responders and non-responders. Age-matched RA patients who were on conventional disease-modifying anti-rheumatic drugs and in remission were enrolled as controls. Subjects were tested for quantitative values of IgA, IgM, IgG RF and anti-citrulinated cyclic peptides (CCP). Further, all subjects were assessed for the disease activity score that includes 28 joints (DAS28) and Stanford Health Assessment Questionnaire (HAQ) 8-item Disability Index (HAQ-DI).
    RESULTS: A total of 31 subjects with RA who had received TNFi and 15 controls were enrolled in this study. There was a trend for the non-responders (n = 10) to have higher levels of all isotypes of RF and anti-CCP. However, only the IgA RF and anti-CCP levels were significantly higher in the non-responder group compared to the responders and controls (P = 0.001, P = 0.034, respectively). On multivariate analysis, only the IgA RF remained significant (OR 0.989; 95% CI 0.980-0.999; P = 0.026).
    CONCLUSION: IgA RF is potentially a novel predictor of response to TNFi in RA patients. Testing for pretreatment IgA RF levels could be a reasonable consideration before commencement of TNFi.
    Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
    Matched MeSH terms: Rheumatoid Factor/immunology; Rheumatoid Factor/therapeutic use*
  13. Osteonecrosis with renal damage in HIV patients undergoing HAART
    Chitra P, Bakthavatsalam B, Palvannan T
    Biomed Pharmacother, 2014 Sep;68(7):881-5.
    PMID: 25194446 DOI: 10.1016/j.biopha.2014.07.017
    Rheumatoid arthritis in HIV patients undergoing HAART is associated with increased risk of side effect. Elevation of uric acid (UA) is important in tissue damage, deposition of crystal in joints leads to the development of rheumatoid arthritis in the HAART complaint group. This study was carried out to investigate the relationship of uric acid, RA factor, ANA, ESR, cystatin C, urea and creatinine in the HAART complaint group. Moreover; the ratio of uric acid/cystatin C, uric acid/urea and uric acid/creatinine were also studied. To analyze the progression of HIV, the immunological parameters were correlated with uric acid. Our result showed a statistically high significant increase in uric acid, RA factor, ANA, ESR, cystatin C, urea and creatinine in the HAART complaint group when compared to HAART non-complaint group, early stage and control. The ratio of uric acid/cystatin C, uric acid/urea, uric acid/creatinine were significantly increased in the HAART complaint group. Statistically significant positive correlation was observed between uric acid and cystatin C, urea, creatinine, absolute CD4 and CD8 count. The increased level of uric acid, RA factor, ANA, ESR, cystatin C and increased ratio of uric acid/cystatin C in the HAART complaint group might conclude the mechanism underlying the increased risk for rheumatoid arthritis in the HAART complaint group which may relate to the combined effects of low-grade inflammation and renal dysfunction.

    Study done in India
    Matched MeSH terms: Rheumatoid Factor/metabolism
  14. Prevalence of anti cyclic citrullinated peptide antibodies in Malaysian rheumatoid arthritis patients and its correlation with disease activity
    Sockalingam S, Chow SK, Sthaneshwar P
    Int J Rheum Dis, 2009 Sep;12(3):211-5.
    PMID: 20374348 DOI: 10.1111/j.1756-185X.2009.01412.x
    AIM: The objectives of this study are to provide data regarding the prevalence of anti-cyclic citrullinated peptide (CCP) antibodies in Malaysian rheumatoid arthritis (RA) patients and to correlate the levels of anti-CCP antibody with the Disease Activity Score (DAS).
    METHOD: We studied the prevalence of anti-CCP antibodies in 51 RA patients attending our clinic and 29 controls. We also looked for correlation between anti-CCP antibody levels with the DAS and parameters such as duration of disease, rheumatoid factor (RF) and disease-modifying anti rheumatic drug (DMARD) usage.
    RESULTS: None of the controls demonstrated anti-CCP antibodies. Forty-one out of 51 patients (80.4%) were positive for anti-CCP antibodies. Sensitivity and specificity were 80.4% and 100% respectively in this study. Anti-CCP levels correlated significantly with rheumatoid factor, but no correlation was observed with the other parameters.
    CONCLUSIONS: Anti-CCP antibody is prevalent in Malaysian RA patients at 80.4% and more sensitive than RF in our cohort of established RA patients. Even though the anti-CCP levels correlated with RF, it did not show correlation with DAS.
    Matched MeSH terms: Rheumatoid Factor/blood
  15. Fulltext Diagnostic value of anti-modified citrullinated vimentin in rheumatoid arthritis
    Maraina CH, Nurdayana AK, Rusni D, Azwany Y
    Int J Rheum Dis, 2010 Oct;13(4):335-9.
    PMID: 21199468 DOI: 10.1111/j.1756-185X.2010.01552.x
    BACKGROUND: Rheumatoid factors (RF) are currently used in the diagnosis of rheumatoid arthritis (RA). Several other autoantibodies found in RA are directed to epitopes in citrullinated proteins such as anti-cyclic citrullinated and recently anti-modified citrullinated vimentin (MCV).
    OBJECTIVE: In this study we determined the sensitivity and specificity of anti-MCV in comparison with anti-cyclic citrullinated peptide (CCP) antibodies and RF in RA patients and in a control group using the American College of Rheumatology (ACR) criteria as the gold standard.
    MATERIALS AND METHODS: A cross sectional study was conducted from January to December 2008 on 100 patients with RA and 153 patients with arthritis or arthralgia but not fulfilling ACR criteria for RA. Serum from each subject was tested for anti-MCV, anti-CCP antibodies and immunoglobulin G (IgG) RF by enzyme-linked immunosorbent assay. Sensitivity and specificity of the tests were evaluated using the ACR criteria as the gold standard.
    RESULTS: The sensitivity of RF was 85% with 74.5% specificity. For anti-CCP antibodies the sensitivity was 71% and the specificity was 94.8%. The sensitivity of anti-MCV antibodies was 80% with 59.5% specificity. The area under the curve for RF was 0.759, for anti-CCP antibodies was 0.866 and for anti-MCV antibodies was 0.681, while for at least one positive test it was 0.691.
    CONCLUSION: Anti-CCP antibodies have higher diagnostic specificity and positive predictive value than RF and anti-MCV antibodies. RF has the highest sensitivity when compared to anti-CCP and anti-MCV antibodies. Thus anti-MCV antibody is not a better marker when compared to RF or anti-MCV antibody in the diagnosis of RA patients.

    Study site: family medicine clinic, rheumatology clinic and immunology laboratory of Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan, Malaysia
    Matched MeSH terms: Rheumatoid Factor/blood
  16. Fulltext The atypical presentation of rheumatoid arthritis in an elderly woman: a case report
    Devaraj NK
    Ethiop J Health Sci, 2019 Jan;29(1):957-958.
    PMID: 30700964 DOI: 10.4314/ejhs.v29i1.18
    The diagnosis of rheumatologic problem can be difficult, especially if not all the diagnostic criteria or typical clinical features are seen. This includes conditions such as rheumatoid arthritis which needs early diagnosis to start disease modifying drugs (DMARDs) which can improve the prognosis and prevent further joint erosion and organ damage. This case report focused on a similar scenario in an elderly woman initially thought to have osteoarthritis but was diagnosed later with rheumatoid arthritis which brought much relief to her current predicament.
    Matched MeSH terms: Rheumatoid Factor/blood
  17. A survey of the primary care management of osteoarthritis in Malaysia: A view from a rheumatologist's perspective
    Arshad A, Rashid R, Das Gupta E
    Int J Rheum Dis, 2008;11(3):246-250.
    DOI: 10.1111/j.1756-185X.2008.00367.x
    Objective: Primary care management of knee osteoarthritis (OA) has received little attention in the scientific literature and the main reason for this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting.
    Methods: A cross-sectional survey of 200 randomly selected general practitioners (GPs) in the peninsular states of Malaysia was undertaken using a questionnaire. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment. They were also asked about their usage of conventional and complementary medication.
    Results: One hundred and eighty (90%) GPs responded to the questionnaires sent: 77% were in solo practice and 33% in group practice. Most of the GPs surveyed (60%) had been in practice for more than 10 years, 30% for 5-10 years and 10% were in practice for less than 5 years. Of GPs surveyed, 55% saw an average of more than 20 patients per week, 35% about 10-20 patients and 10% less than 10 patients per week. Of GPs surveyed, 65% would arrange an X-ray, 55% would arrange a blood test, mostly serum uric acid, rheumatoid factor and erythrocyte sedimentation rate. Pharmacological management consists of first-line treatment with non-steroidal anti-inflammatory drugs (NSAIDs) (61%), analgesics (35%) or a combination of the two (4%). Non-pharmacological management consisted of advice on exercise (27%), weight reduction (33%) and referral to physiotherapy (10%). Of GPs surveyed, 85% prescribed some form of complementary medications, 60% prescribed glucosamine sulphate, 21% chondroitin sulphate, 11% cod liver oil and 9% evening primrose oil. Only 10% of GPs surveyed perform intra-articular injections.
    Conclusion: The data suggest that in the primary care setting, the majority of GPs over-investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesics and NSAIDs. The use of physiotheraphy and non-drug approaches were significantly under-utilized. There is a need to further educate GPs in the management of OA.
    Matched MeSH terms: Rheumatoid Factor
  18. Heterophilic antibody interference affecting multiple hormone assays: Is it due to rheumatoid factor?
    Mongolu S, Armston AE, Mozley E, Nasruddin A
    Scand J Clin Lab Invest, 2016 May;76(3):240-2.
    PMID: 26924790 DOI: 10.3109/00365513.2016.1143113
    Assay interference with heterophilic antibodies has been well described in literature. Rheumatoid factor is known to cause similar interference leading to falsely elevated hormone levels when measured by immunometric methods like enzyme-linked immunosorbent assay (ELISA) or multiplex immunoasays (MIA). We report a case of a 60-year-old male patient with a history of rheumatoid arthritis referred to our endocrine clinic for investigation of hypogonadism and was found to have high serum levels of LH, FSH, SHBG, Prolactin, HCG and TSH. We suspected assay interference and further tests were performed. We used Heteroblock tubes and PEG precipitation to eliminate the interference and the hormone levels post treatment were in the normal range. We believe the interference was caused by high serum levels of rheumatoid factor. Although he was treated with thyroxine for 3 years, we believe he may have been treated inappropriately as his Free T4 level was always normal despite high TSH due to assay interference. Our case illustrates the phenomenon of heterophilic antibody interference likely due to high levels of rheumatoid factor. It is essential for clinicians and endocrinologists in particular to be aware of this possibility when making treatment decisions in these groups of patients.
    Matched MeSH terms: Rheumatoid Factor
  19. Fulltext A pilot study of the primary care management of knee osteoarthritis in the Northern States of Malaysia.
    Arshad, A., Rashid, R.
    International Medical Journal Malaysia, 2008;7(2):31-36.
    MyJurnal
    Introduction: Primary care management of knee osteoarthritis OA has received little attention in the scientific literature and the main reason of this survey is to study and explore the variations and patterns of primary care management and assess both conventional and complementary therapy usage in knee OA in the primary care setting. Materials and Methods: A cross sectional survey of 100 randomly selected general practitioners (GPs) in the northern states of Malaysia (Kedah, Perlis, Pulau Pinang) was undertaken using questionnaires. The GPs involved were asked about basic knowledge of OA in terms of diagnosis, investigation, and treatment of OA. They were also asked their usage of conventional and complementary medication. Results: 80 (80%) GPs responded to the questionnaires sent. 85% of GPs were in solo practice and 15% in group practice. Most of the GPs surveyed (69%) were in practice for more than 10 years, 21% in 5- 10 years and 10% were in practice for less than 5 years. 65% GPs surveyed see an average of more than 20 patients per week, 25% see about 10- 20 patients and 10% see less than 10 patients per week. 75% of GPs surveyed would arrange an X-ray. 65% of GPs surveyed will arrange a blood test, mostly serum uric acid, rheumatoid factor and ESR. Pharmacological management consists of first line treatment with analgesics (32%), NSAIDs (59%) or a combination of the two (4%). Non-pharmacological management consist of advise an exercise (37%), weight reduction (23%) and referral to physiotherapy (8%). 89% of GPs surveyed prescribed some form of complementary medications. 68% prescribed glucosamine sulphate, 29% chondroitin sulphate, 18% cod liver oil, 12% evening primrose oil. Only 5% of GPs surveyed perform intra- articular injection. Conclusion: The data suggest that in the primary care, majority of GP over investigate the diagnosis of OA. Pharmacological interventions largely concentrate on analgesic and NSAIDs. The use of physiotherapy and non drug approach were enormously under-utilized. There is a need to further educate GPs in the management of OA.
    Matched MeSH terms: Rheumatoid Factor
  20. Single-nucleotide polymorphisms of the interleukin-18 gene promoter region in rheumatoid arthritis patients: protective effect of AA genotype
    Sivalingam SP, Yoon KH, Koh DR, Fong KY
    Tissue Antigens, 2003 Dec;62(6):498-504.
    PMID: 14617033 DOI: 10.1046/j.1399-0039.2003.00137.x
    Rheumatoid arthritis (RA) is a chronic arthritic condition that can lead to deformities and disabilities. Although numerous studies reported the association of human leukocyte antigen (HLA)-DRB1*04 and RA, other genes, e.g. cytokines genes, may contribute towards disease susceptibility. Interleukin-18 (IL-18) is a proinflammatory cytokine postulated to play a role in the acute and chronic inflammatory phases of RA. The IL-18 protein expression seems to be regulated by two single-nucleotide polymorphisms (SNPs) located at positions -607 and -137 in the promoter region of the gene. It is postulated that specific alleles may be associated with susceptibility to the development of RA. In the present study, we described the IL-18 gene promoter region genotypes and combined genotypes (-607/-137) in 106 RA patients and 273 unrelated healthy controls to evaluate the contributions of these alleles to RA predisposition in Chinese, Malays, and Indians. The genotyping were performed using sequence-specific polymerase chain reactions. Rheumatoid factors were assayed by enzyme-linked immunosorbent assay. Biodata were obtained through chart review. The controls had significantly higher frequency of AA genotype at position -607 when compared to RA patients. No significant differences were observed in the distribution of either allelic or genotypic frequencies at position -137. There was no association between the genotypes and the presence of rheumatoid factors. This study did not find evidence of a genetic susceptibility factor but demonstrated the novel finding that the AA genotype at position -607 is associated with a protective effect against development of RA in Chinese individuals. This protection may be mediated through inhibition of cyclic (Adenosine 3', 5'-cyclic monophosphate) AMP-responsive element (CRE)-binding protein by the disruption of the CRE consensus sequence.
    Matched MeSH terms: Rheumatoid Factor
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