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What Causes Elevated Levels Of Rheumatoid Factor?

Posted on Mon, 13 Apr 2015

Question: I have a RF of 190 & an anti-ccp of 264. All other labs were negative (ANA, CRP, HLA, etc.). Vectra analysis was 17. In the absence of clinical findings & radiology testing showing OA, why are the RF & anti-ccp so high? Am I likely to develop RA in the future?

Answered by Dr. Tushar Kanti Biswas (5 hours later)

Brief Answer:
your chance of developing RA is relatively high in future.

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

The presence of serum anti-CCP((cyclic citrullinated peptide) antibodies has about the same sensitivity as serum RF for the diagnosis of RA. There is some incremental value in testing for the presence of both RF and anti-CCP, as some patients with RA are positive for RF but negative for anti-CCP and vice versa.

The reference ranges for blood tests of anti–citrullinated protein(CCP) antibodies are:High/strong positive Unit > 60.

High levels of rheumatoid factor (in general, above 20 IU/mL ;there is some variation among labs) occur in rheumatoid arthritis.

Since you are positive for both, your chance of developing RA is relatively high in future.
CRP is non-specific.

ANA is positive only in 30-50 % cases of rheumatoid arthritis.

The individuals with HLA-D4 and HLA-DR 4 are more prone to rheumatoid arthritis.
You have not mentioned details of your HLA results.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Tushar Kanti Biswas (16 hours later)

The lab test for Sjogren's was negative (SSA-9, SSB-0) but my mouth and eyes are extremely dry. Naproxen is my only medication. Thank you.
My ANA and ESR lab tests were negative.

Answered by Dr. Tushar Kanti Biswas (10 hours later)

Brief Answer:
Dry mouth or eyes ? Secondary Sjogren's

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Speckled ANA Pattern:
Ro (SS-A) is present in 60% cases of Sjögrens , ANA(-) lupus.
La (SS-B) is present in 50% cases of Sjögrens.
Lip biopsy is needed when the diagnosis is uncertain or to rule out other conditions that may cause dry mouth or eyes (Sarcoidosis, HIV Infection and Sicca Syndrome etc).
.
Hepatitis C virus infection should be ruled out since (it can cause dry eyes and mouth as well), apart from serologic tests, the remainder of the clinicopathologic picture is almost identical to that of Sjögren's syndrome.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Tushar Kanti Biswas (44 hours later)

Dear Doctor,
Other than having RA, what disease entity would cause high RF and anti-CCP values? Thank you.

Answered by Dr. Tushar Kanti Biswas (2 days later)

Brief Answer:
RA will have the highest levels. Though there are other disorders which have them.

Detailed Answer:
Hi

All the autoimmune conditions I mentioned earlier also will possess some elements of RF and Anti CCP, however they are not as high as those present in Rheumatoid Arthritis.. So sjogren's and lupus too will have those antibodies against citrullinated peptides. But however they are not as specific as for Rheumatoid arthritis.

Regards,

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Above answer was peer-reviewed by : Dr. Pradeep Vitta