What is your approach to a patient with an isolated positive rheumatoid factor, negative anti-CCP antibody, and no clinical or imaging evidence of rheumatoid arthritis?

In our clinic, we screen for hepatitis C infection in all patients with polyarthralgias especially if the RA factor is positive. A positive RA factor is non-specific and can be present in a number of chronic inflammatory conditions, autoimmune and otherwise, including alcoholic liver cirrhosis, hepatitis C infection, Sjogren's syndrome, Parvovirus infection, other chronic infections, e.g., SBE, idiopathic pulmonary fibrosis (IPF), etc.

This is a very common scenario, i.e. patient presenting with isolated positive RF and negative Anti-CCP and no clinical or imaging evidence of rheumatoid arthritis. RF is very non-specific, and we screen these patients clinically and serologically for other connective tissue diseases (especially Sjogren syndrome), infections such as viral hepatitis B/C and Parvovirus B19. Chronic infections such as tuberculosis and osteomyelitis can also cause positive RF. If no other etiology, we usually follow...

There are a significant number of simply false positive RF tests especially as we know in women over 65. I simply discuss ONE HOUR of am stiffness with the patients and discuss the severe but relatively transient stiffness and gelling of OA. I try to do a thorough exam and while doing my exam, look for OA changes in the hands and try to instruct patients on the difference in bony and soft tissue swelling. I may get hand and foot X-rays as a baseline. I discuss palindromic RA and false positive t...