Elevated rheumatoid factor and long term risk of rheumatoid arthritis: a prospective cohort study
Objective To test whether elevated concentration of rheumatoid factor is associated with long term development of rheumatoid arthritis.Design A prospective cohort study, the Copenhagen City Heart Study. Blood was drawn in 1981-83, and participants were followed until 10 August 2010.Setting Copenhage...
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Published in | BMJ (Online) Vol. 345; no. 7878; p. 15 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
England
British Medical Journal Publishing Group
06.09.2012
BMJ Publishing Group BMJ Publishing Group LTD BMJ Publishing Group Ltd |
Subjects | |
Online Access | Get full text |
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Summary: | Objective To test whether elevated concentration of rheumatoid factor is associated with long term development of rheumatoid arthritis.Design A prospective cohort study, the Copenhagen City Heart Study. Blood was drawn in 1981-83, and participants were followed until 10 August 2010.Setting Copenhagen general population.Participants 9712 white Danish individuals from the general population aged 20-100 years without rheumatoid arthritis at study entry.Main outcome measures Rheumatoid arthritis according to baseline plasma IgM rheumatoid factor level categories of 25-50, 50.1-100, and >100, versus <25 IU/mL.Results Rheumatoid factor levels were similar from age 20 to 100 years. During 187 659 person years, 183 individuals developed rheumatoid arthritis. In healthy individuals, a doubling in levels of rheumatoid factor was associated with a 3.3-fold (95% confidence interval 2.7 to 4.0) increased risk of developing rheumatoid arthritis, with a similar trend for most other autoimmune rheumatic diseases. The cumulative incidence of rheumatoid arthritis increased with increasing rheumatoid factor category (Ptrend<0.0001). Multivariable adjusted hazard ratios for rheumatoid arthritis were 3.6 (95% confidence interval 1.7 to 7.3) for rheumatoid factor levels of 25-50 IU/mL, 6.0 (3.4 to 10) for 50.1-100 IU/mL, and 26 (15 to 46) for >100 IU/mL, compared with <25 IU/mL (Ptrend<0.0001). The highest absolute 10 year risk of rheumatoid arthritis of 32% was observed in 50-69 years old women who smoked with rheumatoid factor levels >100 IU/mL.Conclusion Individuals in the general population with elevated rheumatoid factor have up to 26-fold greater long term risk of rheumatoid arthritis, and up to 32% 10 year absolute risk of rheumatoid arthritis. These novel findings may lead to revision of guidelines for early referral to a rheumatologist and early arthritis clinics based on rheumatoid factor testing. |
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Bibliography: | ArticleID:nies003263 istex:3820D5AAFD50BF9DB8A8DE76D43E3C498520C3D5 ark:/67375/NVC-NXNMT0JH-T local:bmj;345/sep06_2/e5244 href:bmj-345-bmj-e5244.pdf ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0959-8138 1756-1833 1756-1833 |
DOI: | 10.1136/bmj.e5244 |