Background/Purpose:  Several studies have reported increased overall mortality in association with rheumatoid factor (RF) in RA. However, the clinical significance including health outcomes of RF in general populations are incompletely known. Thus, the aim of this study was to determine the association of RF with mortality due to all-causes, cardiovascular disease (CVD), and cancer-cause in Koreans without RA participating in a health-screening program. Furthermore, we analyzed whether the titers of RF had implication for the mortality outcome in healthy screening subjects.

Methods:  A cohort study was performed in 295,837 participants free of osteoarthritis or rheumatoid arthritis (RA), and who had undergone health screening between 2002 and 2012 and been followed-up to determine the risk of all-cause, CVD, and cancer-specific mortality with respect to the presence or titer of RF. To determine whether the participants were deceased, we used National Death Index death certificates.

Results:  The prevalence of RF positivity (≥ 20 IU/mL) was 4.4%. During 1,447,403 person-years of follow-up, 1,402 participants died. Comparing subjects with RF-negativity with those positive for RF in a sex-adjusted model, the HRs for all-cause and cancer mortality were 1.66 (95% CI = 1.39–1.98) and 1.84 (95% CI = 1.44–2.35), respectively. After adjusting for confounding factors, RF positivity was still significantly associated with the risk for all-cause or cancer mortality (HR=1.50, 95% CI = 1.19–1.90; HR=1.56, 95% CI = 1.12–2.16, respectively). However, the HR for cardiovascular mortality was not higher in subjects with RF-positivity than in those with RF-negativity (HR=0.98, 95% CI=0.45–2.11). The HRs for all-cause, CVD, and cancer mortality were estimated in terms of RF levels. After adjusting for confounding factors, all-cause and cancer mortality risk was significantly greater in subjects with an RF titer greater than 100 IU/mL than in those with RF-negativity (HR=2.68, 95% CI=1.72–4.19; HR=2.89, 95% CI=1.58–5.28, respectively). On the other hand, RF titer did not show significant association with an increased risk of CVD mortality.

Conclusion:  In healthy South Korean examinees without RA, RF was associated with a greater risk of all-cause and cancer mortality, suggesting that it predicts greater mortality, even among the apparently healthy population. This result would shed new light on the clinical significance of RF on mortality in the general populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-factor-positivity-increases-all-cause-and-cancer-mortality-risk-in-korean-healthy-examinees-a-kangbuk-samsung-health-study/