Nossent Johannes, Raymond Warren, Divitini Mark, Knuiman Matthew
School of Medicine & Pharmacology, The University of Western Australia, 35 Stirling Hwy (M503), Crawley, WA, 6009, Australia.
Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
BMC Musculoskelet Disord. 2017 May 26;18(1):221. doi: 10.1186/s12891-017-1598-x.
Rheumatoid Factors (RF) are antibodies directed against the Fc portion of IgG and are involved in clearance of immune complexes. While RF can develop in a wide range of conditions, higher RF levels indicate a greater risk for a severe disease course in Rheumatoid Arthritis (RA) patients including cardiovascular complications and premature death. We investigated whether RF also constitute a risk factor for these outcomes in the general population.
We included 2,323 participants (46% male, mean age 50 years) free of CVD at baseline in 1972. RF positivity was defined as a score of ≥2 by latex agglutination (scale 0-5). All outcomes during 42-year follow-up were obtained from state-wide registries. The predictive value of RF for coronary heart disease, all cardiovascular disease and all-cause mortality was estimated by adjusted hazard ratios (HR) from Cox regression models.
After adjustment for standard risk factors, RF positivity was not predictive of future CHD (HR 1.05, p = 0.61), CVD (HR 1,04, p = 0.63) or mortality (HR 1.03, p = 0.70) in the full CVD-free cohort. In an interaction model, RF in 41 out of 355 participants with an RA history was not predictive of CHD (HR 0.92, p = 0.77) or CVD events (HR 1.15, p = 0.51), but there was a borderline significant association with overall mortality (HR 1.41, CI 0.97-2.04, p = 0.07).
RF detected by Latex agglutination do not independently predict future CHD, CVD or death in the general population. However, the presence of RF in the context of a history of RA is associated with a moderate, borderline significant increase in the long term adjusted risk for all-cause mortality.
类风湿因子（RF）是针对IgG Fc部分的抗体，参与免疫复合物的清除。虽然RF可在多种情况下出现，但较高的RF水平表明类风湿关节炎（RA）患者出现严重疾病进程的风险更大，包括心血管并发症和过早死亡。我们调查了RF在普通人群中是否也是这些结局的危险因素。
我们纳入了1972年基线时无心血管疾病（CVD）的2323名参与者（46%为男性，平均年龄50岁）。RF阳性定义为乳胶凝集试验得分≥2（范围0 - 5）。42年随访期间的所有结局均来自全州登记处。通过Cox回归模型的调整风险比（HR）估计RF对冠心病、所有心血管疾病和全因死亡率的预测价值。
在调整标准危险因素后，在整个无CVD队列中，RF阳性不能预测未来冠心病（HR 1.05，p = 0.61）、CVD（HR 1.04，p = 0.63）或死亡率（HR 1.03，p = 0.70）。在一个交互模型中，355名有RA病史的参与者中有41名的RF不能预测冠心病（HR 0.92，p = 0.77）或CVD事件（HR 1.15，p = 0.51），但与总体死亡率有边缘显著关联（HR 1.41，CI 0.97 - 2.04，p = 0.07）。
乳胶凝集试验检测到的RF不能独立预测普通人群未来的冠心病、CVD或死亡。然而，在有RA病史的情况下，RF的存在与全因死亡率的长期调整风险适度、边缘显著增加相关。
