ASSESSMENT OF REQUEST PATTERN AND UTILITY OF RHEUMATOID FACTOR IN A TERTIARY HOSPITAL IN NORTH EAST NIGERIA
Background: The diagnostic utility of Rheumatoid Factor (RF) test is not well documented. The question therefore is: 'when is it appropriate to make this request'? When patients' own immunological defense mechanisms go awry and start attacking one's tissues, (autoimmune), there u...
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| Autores principales: | , , , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Ntec Specialist
2019
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/ee5566d324884f5f961a1ad10c6c2397 |
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| Sumario: | Background: The diagnostic utility of Rheumatoid Factor (RF) test is not well documented. The
question therefore is: 'when is it appropriate to make this request'? When patients' own
immunological defense mechanisms go awry and start attacking one's tissues, (autoimmune), there
usually arises a problem. This usually affects the heart, musculoskeletal system and other organs
giving rise to signs and symptoms that are seen in other ailments. The joints are the most common site
of affectation and an early diagnosis may go a long way in managing the disease. Usually an antibody
(Rheumatoid factor) is found in such patients. It is formed against the Fc portion of IgG, forming an
IgG-Fc immune complex that normally leads to the disease process. It is this complex (usually an IgM)
in the patient's serum that is exposed to a commercial antigen in the laboratory and the titer
determined against a standard. The normal level is usually less than 14IU/ml. Levels higher are usually
considered abnormally high, elevated or positive. A negative RF test however does not mean that the
patient hasn't got the disease. Objective: To determine the frequency of positivity of rheumatoid
factor and the context in which the requests are made by group of physicians and advise on when to
make the request. Methods: A retrospective study of case notes of 354 patients requested to perform
rheumatoid factor test at the immunology department over a period of 6 years were reviewed. The
requesting departments, clinical and demographic characteristics of patients were reviewed and
analyzed. Data analyzed using SPSS version 22. Results: Of the 354 requests made, 265 (74.9%) were
due to musculoskeletal symptoms and 20 (5.6%) were positive for RF. Of the 20, 19 (95%) had
polyarthritis while 1 (5%) was asymptomatic. The mean age was 37.06±13.91 and 205 (57.9%) were
females. Most (137 or 38.7%) of requests for RF were from the general out-patient department and 108
(30.5%) from medical out-patient department. The sensitivity and specificity for RF test in detecting
MSK disease were 7.17% (95%CI, 4.37-10.97) and 98.88% (95%CI, 93.90-99.97). The positive likelihood ratio
was 6.38% (95% CI, 0.87-40.99). The positive predictive value (PPV) and negative predictive
value (NPV) were 95.0% (95%CI, 77.02-99.29) and 26.35% (95%CI, 25.48-35.30). Test accuracy was
30.23% (95% CI, 25.48-35.30). Conclusion: We recommend that rheumatoid factor should be
requested only in patients with fleeting arthritis, good clinical evaluation for signs and
symptoms and looking for differentials |
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