Immune complexes in sera and synovial fluids of patients with rheumatoid arthritis. Radioimmunoassay with monoclonal rheumatoid factor

Evidence for the presence of immune complexes in blood, synovial fluid, and tissues of patients with rheumatoid arthritis (RA) includes low complement levels in blood and effusions, deposition of immunoreactants in tissues and vessel walls, and precipitates formation after addition of monoclonal rheumatoid factor (mRF) to serum or synovial fluid. To quantitate immune complex like material in RA patients, we developed a radioimmunoassay based on inhibition by test samples of the interaction of [¹²⁵I]aggregated IgG (agg IgG) and mRF coupled to cellulose. This method could measure immune complexes of human antibody with hemocyanin prepared in vitro. The assay was not influenced by presence of polyclonal RF in test samples, nor by freezing and thawing. Normal levels of immune complex like material in serum were less than 25 μg agg IgG eq/ml. 12 of 51 RA sera examined (26%) contained more than 25 μg/ml. The presence of this material in RA sera was found to correlate with severity of disease, as measured by anatomical stage and functional class. There was an inverse correlation of the material with serum C4 level. Rheumatoid synovial fluids generally contained higher levels than serum, and five of 23 contained very much higher levels. The frequency of elevated levels of immune complex like material in sera of patients with systemic lupus erythematosus (2 of 29) and with miscellaneous vasculitides (2 of 21) was much lower than in RA, suggesting that mRF exhibits a specificity for only certain kinds of immune complexes. The reason for this apparent specificity may explain such distinctive features of RA as the high frequency of polyclonal RF, the lack of immune complex nephritis, and the generally normal levels of serum complement.