rising Rheumatoid Factor titers and prognosis

[sarahjames]

Hello from England!  I hope you can help: about 3 years ago (when I was 41)I was diagnosed with sero-negative SLE, a diagnosis which has since been modified by my rheumatologist to 'non-differentiated rheumtoid disease'. Although I am seronegative for SLE-specific antigens, my Rheumatoid factor level was high on initial diagnosis at 490.  Since then it has risen to 530, and this week to 671!!! On reflection, I can recall a strange flu-type illness in 1998 which caused both my wrists to swell painfully, and then my fingers.  I didn't see my doctor at the time, but a couple of years later my symptoms were such that I was tested for RA and referred.

I have been on plaquenil since diagnosis, and diclofenac, recently changed to eccoxolac as the stiffness etc was getting worse.  I have photosensitivity, a vague butterfly rash (I think; fatigue; painful joints - often symmetrical, but without the fiery-hot swellings I believe are associated with RA.  My mother has RA, as do several of her maternal relatives. I have very low serum ferritin levels (6) and have been on high doses of iron for two years.  Latterly my Hb has risen to 15, so my GP has stopped Fe supplements, and my serum iron is ok.  My anaemia I think dates back 3 years ago to a miscarriage in which I haemorrhaged.  

I work full-time as a university lecturer, but receive support from occupational health.  I have 3 children, and smoke about 15-20 cigarettes per day - but am planning to stop in the next few days! I had glandualr fever when I was 13.

I guess I want to have a clearer idea of what it is I may have - and what the rising, high RF titers signify, if anything.  How does RF affect the body, and what do my RF levels suggest in prognostic terms?

I hope you can clarify things for me!
Many thanks

[Rhino7777]

A related discussion, RA factor and CLL was started.

[sarahjames]

Thank you for your comments.  I am still keen, if possible, to have a clearer understanding of the nature of my rheumatoid disease in relation to the high RF titers - I know the biliary cirrhosis and cancer suggestions are not applicable for me, but I forgot to mention that I have symptoms also of Sjogren's syndrome.

Is it more likely to be RA or lupus?  How much higher can the titers go?  What can bring them down?

[Kevin Pho, MD]

There are several issues with the RF titer.  Other chronic inflammatory disease can affect the utility of the titer - this can include chronic infection, malignancy, or primary biliary cirrhosis.  

Those with higher RF titers may experience more severe symptoms in association with their disease - specifically erosive diease and extraarticular manifestations.  However, there will be wide patient variability on this issue.

One can measure the HLA-DRB1 levels - which in association with the RF can give a more accurate prognostic indicator of their disease.

Regarding the function of RF - this is poorly understood.  Some possible functions include the following (from UptoDate):
* Binding and processing of antigens embedded in immune complexes.
* Presentation of antigens to T lymphocytes in the presence of HLA molecules.
* Immune tolerance.
* Amplification of the humoral response to bacterial or parasitic infection.
* Immune complex clearance.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com