In 1940, Waalerl reported the presence of a factor in human serum which caused the agglutination of amboceptor-sensitized sheep erythrocytes. He named this factor the agglutinating activating factor and found it in the sera of 35% of 50 rheumatoid arthritis patients and 9% of 202 controls (patients with cancer, peptic ulcer, pneumonia, neurasthenia, etc). This factor was discovered in 1922, as Waaler pointed out, by Meyer,2 who, in the examination of 100,000 sera for the Wasserman reaction, found ten sera that agglutinated sensitized sheep erythrocytes. The first serum was from a patient with liver cirrhosis, and the second was from a patient with chronic bronchitis. Thus, rheumatoid factors were really first discovered in nonrheumatoid diseases. In this survey of the work of our laboratories and others, patients having possible as well as definite connective tissue diseases were omitted. The sensitizedsheep cell agglutination tests (SSC) used were either the differential-agglutination test3 or the heterophile absorbed test serum m~di f i ca t ion ,~~ usually the latter. The human fraction I1 (Hu FII) studies were mainly latex FII precipitation tests? although some were FII tanned sheep cell tests.5 TABLE 1 shows that the incidence of seropositive tests increases with age. Although the positive titers were generally low, some of the SSC titers in healthy donors were as high as 1 :256. One such patient had a 22s component in the serum and did not develop rheumatoid arthritis over a two-year follow-up.e In a study done in the United States, there was a higher incidence of seropositive individuals among women and Negroes.Io It was also found that there were more seropositive individuals in Africa in those tribes that had poor nutrition.11 Rheumatoid factor is present in significant numbers of older individuals having degenerative diseases: 30% of 235 patients with an average age of 71 years (excluding those with tuberculosis, syphilis, lung disease, and sarcoidosis) were Hu FII positive; among these, 64% of those with Parkinsonism, 47% of those with diabetes mellitus, and 17% of those with arteriosclerotic cardiovascular disease were seropositive.12 TABLE 2 shows that patients may have rheumatoid factors in their sera in the course of infectious diseases. In fact, tests for rheumatoid factors have been used to help confirm the diagnosis of subacute bacterial endocarditis (SBE). Following remission of SBE in one to two months, the titers fall to zero, and it has been suggested that this is due to absence of the antigenic stimulus.24 The viral diseases studied showed 1617% seropositivity and include viral pneumonia, influenza, and herpes zoster; as in SBE with remission the tests became negati~e.1~ In six cases of rubella synovitis, the Hu FII tests were positive in two, and one of these was SSC positive. 14@b*39 The incidence of seropositive individuals is higher in infectious hepatitis than in any other viral disease except infectious mononucleosis. Parasitic diseases, especially when accompanied by involvement of the liver

Distribution of rheumatoid factor activity in nonrheumatoid states.

A systematic, quantitative review of blood autoantibodies in schizophrenia

Aim: To assess the frequency of, and factors associated with, depression and anxiety in Singaporean patients with rheumatoid arthritis (RA).

Method:  One hundred RA patients were recruited in a cross-sectional study. Socio-demographics, severity of anxiety and depression, disease activity, levels of serological markers and health-related quality of life were analyzed.

Results:  Twenty-six percent presented with anxiety, 15% with depression and 11% with both. Univariate regression showed that age (P = 0.039), Disease Activity Scale (DAS-28) (P < 0.001), number of medications (P < 0.001) and rheumatoid factor (RF) (P < 0.001) were positively associated with severity of depression, while income (P = 0.001), education (P = 0.029), self-perceived social support (P = 0.007), Short form 12 (SF-12) physical health (P < 0.001) and SF-12 mental health (P < 0.001) were negatively associated with severity of depression. After adjustment for confounding factors in multivariate regression, income (β = −0.347, P = 0.018), RF (β = 0.304, P = 0.043) and SF-12 mental health (β = −0.501 P = 0.001) remained significantly associated with depression. Univariate regression showed that DAS-28 (P = 0.009), number of medications (P = 0.004) and RF (P = 0.043) were positively associated with anxiety, while income (P = 0.022), self-perceived social support (P = 0.04), SF-12 physical health (P < 0.001) and SF-12 mental health (P < 0.001) were negatively associated with anxiety. After adjustment for confounding factors, no factors remained significantly associated with anxiety.

Conclusion:  Low income, high levels of RF and poor mental health were associated with depression in RA. Our findings may help to formulate depression screening strategies. Further research is required to identify the role of RF in depression.

Clinical and psychosocial factors associated with depression and anxiety in Singaporean patients with rheumatoid arthritis

VARIOUS abnormalities of serum Proteins and autoimmune phenomena have been reported in conjunction with schizophrenic illness.1This study reports differences in the major immunoglobulin (yglobulin) classes, IgG, IgA, and IgM, among hospitalized acute, chronic and remitted schizophrenic patients, nonschizophrenic psychiatric patients, and nonmental patient controls. Background Elevation of y-globulin2-8and of 19S macroglobulin9,10has been reported in the sera of acute and chronic schizophrenic patients. Hypermacroglobulinemia wasnotfound in a group of drug-free schizophrenic patients11 nor correlated with illness in monozygotic twins discordant for schizophrenia.12Solomon and co-workers found a slight positive correlation between severity of psychotic symptoms and 19S level in chronic schizophrenic patients.13Qualitative as well as quantitative disturbances in electrophoretic serum protein patterns in schizophrenic patients (some (drug-free) have been described including: splitting of α2globulin, a line superimposed in the gamma

Immunoglobulins in Psychiatric Patients

A Review of the Psychological Aspects of Rheumatic Diseases

The existence of agglutinating substances reactive with autologous and isologous human gamma globulin (yG) has been recognized for some time. These substances were first found in patients with rheumatoid arthritis and were consequently termed \"rheumatoid factor\" (RF). It is now clear that rheumatoid factor is not specific for rheumatoid arthritis, but occurs in individuals with a wide variety of other diseases characterized by inflammation, infection, and/or granulomatous formation. Hepatitis, primary biliary cirrhosis, leprosy, syphilis, and subacute bacterial endocarditis are but a few of the other diseases unrelated to rheumatoid arthritis in which some degree ofRF activity has been observed. RF has been detected in a high proportion of aged individuals, and is known to occur occasionally in healthy younger persons. Experimentally, rheumatoid-like factor has been induced in rabbits after repeated immunization with various antigens. Since rheumatoid factors derived from various human sources share the ability to react with some form of yG immunoglobulin, they have been sometimes referred to as \"anti-yG factors\". As part of a survey of the presence of rheumatoid factor in various populations, it was decided to examine patients newly admitted to an acute psychiatric voluntary hospital who were free of coexisting physical illness, known to be associated with RF, and who had not been subjected to long periods of institutional confinement just before testing. This study was originally prompted by the casual observation of transient RF activity in a patient during a period of severe depressive psychosis.

https://ard.bmj.com/content/annrheumdis/27/1/60.full.pdf

H Meadow

Papers

Rheumatoid factors in an acute psychiatric population.