The rheumatoid factor: an analysis of clinical utility
Article Abstract:
Evaluation of patients with musculoskeletal problems often includes a laboratory test for the rheumatoid factor (RF), an antibody made against the common stem portion of a group of antibodies. The test is performed because a positive result is suggestive of the presence of rheumatoid arthritis (RA) or a related autoimmune disease in which the body inappropriately makes antibodies against its own molecules. However, the occurrence of detectable RF levels increases with age, so the significance of a positive test is not always clear. Even in patients with definitive RA, the significance is uncertain; although many patients with RF have a poorer prognosis, others do well, while others without RF do poorly. To better distinguish the clinical situations in which this test is useful, the positive predictive value for RA, which is dependent on disease prevalence, was evaluated and interpretation of the test was discussed. Even with a high true-positive rate and low false positive rate, the test is more useful and should be restricted to patients for whom there is a moderate suspicion that RA is present. Other diseases and aging increase the rate of false negatives, so that the test results may difficult to interpret. Up to 35 percent of RA patients may have false RF results, so that a negative RF may not provide much valid information. This test is not useful in screening large numbers of people for whom there is a low suspicion of RA. Repeated RF tests provide little medical information in patients with RA, although they may be helpful for patients with Sjogren's syndrome or cryoglobulinemia. Health care costs due to the inappropriate use of this test might be reduced if the test was ordered more selectively. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Localized rheumatoid vasculitis presenting as acute alithiasic cholecystitis
Article Abstract:
Rheumatoid arthritis is a joint disease characterized by pain, inflammation, stiffness, and swelling of the joints, and overgrowth of cartilage tissue. This condition may be complicated by vasculitis, or inflammation of blood vessels, which is difficult to differentiate from polyarteritis nodosa, an inflammatory disease of the small- and medium-sized arteries. A case is described of a 69-year-old woman with rheumatoid arthritis, who developed vasculitis of the gallbladder. The patient had a history of high blood pressure, abnormal heart rhythm, and rheumatoid arthritis. She was admitted to the hospital with a bleeding stomach ulcer. After surgery to treat the ulcer, she developed a rapid heart rate, high temperature, and congestive heart failure. She was treated with antibiotics, but had no evidence of bacterial infection. Her abdominal pain worsened and blood pressure dropped. Diagnostic imaging tests revealed distention, or fullness, of the gallbladder, but no gall stones. Although the gallbladder was removed, her fever persisted. Microscopic tissue examination of the gallbladder revealed physical changes consistent with vasculitis, including the accumulation of inflammatory cells. The patient was treated with prednisolone, and her fever resolved. After the prednisolone dose was reduced, the patient developed recurrent bacterial infections and died of respiratory failure. This is the first reported case of rheumatoid arthritis-related vasculitis localized in the gallbladder. In this case, rheumatoid vasculitis was complicated by bleeding of the digestive tract. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Prevalence of granular lymphocyte proliferation in patients with rheumatoid arthritis and neutropenia
Article Abstract:
Increased numbers of granular lymphocytes, a type of white blood cell associated with immunologic factors and a decrease in number of neutrophils (neutropenia), is thought to occur in some cases of rheumatoid arthritis. (A neutrophil is a granule-containing white blood cell, granulocyte.) Felts's syndrome is the association of neutropenia and an enlargement of the spleen. This paper attempts to associate the occurrence of Felts's syndrome in patients with granular lymphocyte proliferation with rheumatoid arthritis. The authors conclude that proliferation of granular lymphocytes, and decreased levels of neutrophils (with or without increased spleen size) in rheumatoid arthritis commonly resembles Felts's syndrome. However, the relatively large fraction of deaths (due to cancer and infection) in typical Felts's syndrome patients suggest that their survival time may be comparatively less than those with granular lymphocyte proliferation.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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