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Spontaneous synthesis of IgM rheumatoid factor by blood mononuclear cells from patients with rheumatoid arthritis: effect of treatment with gold salts or D-penicillamine.

Spontaneous IgM rheumatoid factor (sIgM RF) synthesis in vitro by blood mononuclear cells (BMC) from rheumatoid arthritis (RA) patients has been previously shown to correlate with disease activity. Ten active RA patients were studied prior to and after the start of therapy with gold salts or penicillamine. sIgM RF decreased steadily over the period of study and was strongly correlated with mean joint count (r =0.94, p less than 0.001), erythrocyte sedimentation rate (r = 0.90, p = 0.014), and duration of morning stiffness (r = 0.78, p = 0.068). In 9 patients with significant decreases, mean sIgM RF was 8% of the initial value after 9 weeks of treatment. The decrease in sIgM RF was relatively specific since the ratio of sIgM RF to total spontaneous IgM synthesis (sIgM) declined during the treatment period. The results indicate that changes in sIgM RF constitute a sensitive indicator of disease activity and response to therapy in RA.