INCREASED MUCOSAL SYNTHESIS OF RHEUMATOID-FACTOR (RF) IN CELIAC-DISEASE

Increased serum levels of RF have been reported in patients with glute n sensitivity. The objective of this study was to investigate the in v ivo secretion of different isotypes of RF in the small bowel in coelia c disease. Nineteen patients were investigated by perfusion of a defin ed jejunal segment, and the jejunal perfusion fluid was analysed for t he presence of IgA and IgM anti-Fc (TgC), Five of the patients studied had serum IgA deficiency. Patients With parrial/subtotal villous atro phy but no IgA deficiency (n = 7) had a four-fold increase of IgM-RF ( P < 0.001) and a three-fold increase of IgA-RF (P < 0.001) compared wi th healthy controls (n = 29). Patients with normal jejunal mucosa but no IgA deficiency (n = 7) had similar IgA-RF and IgM-RF concentrations to healthy controls. Patients with serum IgA deficiency had no ISA-RF detectable in jejunal fluid but the highest ISM-RF concentrations, in particular in active disease, The coeliac patients had serum levels o f IgA-RF and IgM-RF within the reference ranges. Jejunal fluid levels of IgA-RF and IgA-anti-gliadin antibodies were significantly correlate d (P < 0.001), The data indicate that enhanced jejunal mucosal product ion of RF occurs above all in active coeliac disease. The findings sug gest that the immune response to gluten induces a mucosal RF synthesis .