Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis
Objective The first biomarker associated with the rheumatoid arthritis is rheumatoid factor (RF) and since the earliest reports a role has been proposed in the diagnosis and in the prediction of clinical features and outcome. The study of RF isotypes has further attempted to improve diagnostic accur...
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BMJ Publishing Group
2023-08-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/9/3/e002817.full |
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| author | Nicola Bizzaro Franco Franceschini Maria Infantino Carlo Selmi Gian Domenico Sebastiani Francesca Motta Davide Giavarina Boaz Palterer |
| author_facet | Nicola Bizzaro Franco Franceschini Maria Infantino Carlo Selmi Gian Domenico Sebastiani Francesca Motta Davide Giavarina Boaz Palterer |
| author_sort | Nicola Bizzaro |
| collection | DOAJ |
| description | Objective The first biomarker associated with the rheumatoid arthritis is rheumatoid factor (RF) and since the earliest reports a role has been proposed in the diagnosis and in the prediction of clinical features and outcome. The study of RF isotypes has further attempted to improve diagnostic accuracy and identify specific subgroups of patients. The main objective of this study is to provide an analysis of the literature on the role of RF isotypes in the diagnosis and prognosis of rheumatoid arthritis (RA).Methods We performed a systematic literature review and meta-analysis on the role of RF isotypes in RA (only in English, from PubMed, search terms: “rheumatoid factor isotypes”, “diagnosis”, “prognosis” and “rheumatoid arthritis”, last search 31 July 2022, two independent assessment of quality and biases, results included in tables and in the meta-analysis).Results Thirty-six articles were examined (7517 patients). Testing all RF isotypes with latex test or nephelometry allows for the highest sensitivity (68.6%, 95% CI 66.2% to 71.0%); nonetheless, the determination of IgA isotype provides the highest specificity (91.4%, 95% CI 90.8% to 92.0%) and the highest positive likelihood ratio (7.7, 95% CI 5.7 to 10.4). When testing IgM isotype the highest diagnostic OR (21.7, 95% CI 16.1 to 29.3) is reached. When analysing anti-citrullinated protein antibodies, RF isotype determination increases diagnostic accuracy. On the other hand, these do not provide relevant prognostic information, as results are conflicting.Conclusions Testing RF allows the highest sensitivity, while IgA isotype the highest specificity and positive likelihood ratio for RA diagnosis. On the other hand, determination of RF isotypes dose not allow prognostic information, as data are limited and heterogeneous. |
| format | Article |
| id | doaj-art-6cee7c4ab3054dd683d6fd7f9a1c322f |
| institution | Kabale University |
| issn | 2056-5933 |
| language | English |
| publishDate | 2023-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-6cee7c4ab3054dd683d6fd7f9a1c322f2025-02-03T09:55:15ZengBMJ Publishing GroupRMD Open2056-59332023-08-019310.1136/rmdopen-2022-002817Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysisNicola Bizzaro0Franco Franceschini1Maria Infantino2Carlo Selmi3Gian Domenico Sebastiani4Francesca Motta5Davide Giavarina6Boaz Palterer7Laboratory of Clinical Pathology, Azienda Sanitaria Universitaria Integrata, Udine, Italy1 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyLaboratory of Immunology and Allergology, Ospedale San Giovanni di Dio, Firenze, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, ItalyUOC di Reumatologia, Azienda Ospedaliera San Camillo Forlanini, Roma, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, ItalyDepartment of Laboratory Medicine, St Bortolo Hospital, Vicenza, Italy1University of Florence, Department of Clinical and Experimental Medicine, Firenze, ItalyObjective The first biomarker associated with the rheumatoid arthritis is rheumatoid factor (RF) and since the earliest reports a role has been proposed in the diagnosis and in the prediction of clinical features and outcome. The study of RF isotypes has further attempted to improve diagnostic accuracy and identify specific subgroups of patients. The main objective of this study is to provide an analysis of the literature on the role of RF isotypes in the diagnosis and prognosis of rheumatoid arthritis (RA).Methods We performed a systematic literature review and meta-analysis on the role of RF isotypes in RA (only in English, from PubMed, search terms: “rheumatoid factor isotypes”, “diagnosis”, “prognosis” and “rheumatoid arthritis”, last search 31 July 2022, two independent assessment of quality and biases, results included in tables and in the meta-analysis).Results Thirty-six articles were examined (7517 patients). Testing all RF isotypes with latex test or nephelometry allows for the highest sensitivity (68.6%, 95% CI 66.2% to 71.0%); nonetheless, the determination of IgA isotype provides the highest specificity (91.4%, 95% CI 90.8% to 92.0%) and the highest positive likelihood ratio (7.7, 95% CI 5.7 to 10.4). When testing IgM isotype the highest diagnostic OR (21.7, 95% CI 16.1 to 29.3) is reached. When analysing anti-citrullinated protein antibodies, RF isotype determination increases diagnostic accuracy. On the other hand, these do not provide relevant prognostic information, as results are conflicting.Conclusions Testing RF allows the highest sensitivity, while IgA isotype the highest specificity and positive likelihood ratio for RA diagnosis. On the other hand, determination of RF isotypes dose not allow prognostic information, as data are limited and heterogeneous.https://rmdopen.bmj.com/content/9/3/e002817.full |
| spellingShingle | Nicola Bizzaro Franco Franceschini Maria Infantino Carlo Selmi Gian Domenico Sebastiani Francesca Motta Davide Giavarina Boaz Palterer Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis RMD Open |
| title | Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis |
| title_full | Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis |
| title_fullStr | Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis |
| title_full_unstemmed | Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis |
| title_short | Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis |
| title_sort | rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis a systematic review and meta analysis |
| url | https://rmdopen.bmj.com/content/9/3/e002817.full |
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