| M. Kaneko1, S. Nishinarita1, N. Kitamura1,
Y. Tomita1, Y. Matsukawa1, S. Sawada1, T. Horie1, N. Tanaka2,
Y. Arakawa2 |
(1)First Department of Internal Medicine,
Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku,
Tokyo 173-8610, Japan Tel. +81-3-3972-8111 (ext. 2402); Fax +81-3-3972-2893
e-mail: fwhs4775@mb.infoweb.ne.jp
(2)Third Department of Internal Medicine,
Nihon University School of Medicine, Tokyo, Japan |
Abstract We studied isotype-specific rheumatoid
factors (RFs) to clarify their significance in rheumatoid arthritis
(RA) and to verify the difference in RF isotypes between RA and
chronic liver diseases (CLD). Isotype-specific RFs in RA and in
CLD were measured by enzyme-linked immunosorbent assay (ELISA).
Most sera (n = 51, 94.1%) from RA patients contained some kind
of RF isotypes (92.1% for IgM RF, 76.4% for IgG RF, and 43.1% for
IgA RF), and seronegative RA by ELISA was seen in only 11.8% (n
= 6). The most characteristic combination of RF isotypes in active
RA was IgG, IgA, and IgM. This combination of RF isotypes changed
to IgG plus IgM, according to the diminution of RA activity; then,
we found only IgM RF in inactive RA. The titers of each RF isotype
also decreased in parallel with the activity of RA. IgA RF seemed
to be the most sensitive factor for evaluating the activity of
RA. In CLD, almost the same high frequency (n = 49, 89.8% for IgM
RF, 59.2% for IgG RF), with the same titer levels seen in RA, was
observed. On the other hand, IgA RF was significantly lower in
frequency (n = 9, 18.4%) and in titer, compared with the finding
in RA. Surprisingly, even in CLD, true seronegativity by ELISA
was also found in very few patients (n = 4, 8.1%). In CLD, positive
RFs detected by agglutination assay were seen more often in chronic
hepatitis than in liver cirrhosis. In RA patients, significant
associations of IgA RF and the serum concentration of IgA, and
IgG RF and the serum concentration of IgG, were observed. On the
other hand, in CLD patients, significant associations of IgG RF
and the serum IgG concentration, and of IgM RF and the serum IgM
concentration, were observed. These results indicated that IgA
RF in active RA is the most characteristic RF isotype distinguishing
it from other nonrheumatic diseases, as well as from inactive RA.
RF isotypes reflected the background polyclonal B-cell activation
in different manners in both diseases. In CLD, RF isotypes seemed
to be disease-related immunological disorders reflecting disease
progression.
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