SLIDE TEST FOR RHEUMATOID FACTORS

SUMMARY
Sometimes autoantibodies are produced by the human body against self antigens. The precise role that this aberrant
immunity plays in the pathogenesis of certain rheumatic diseases is unknown. However the presence of these
autoantibodies serves as credible marker of the disease.
In rheumatoid arthritis, diagnostically useful autoantibodies termed as "Rheumatoid factors" (RF) can be detected which
are immunoglobulins of the class IgM, IgG, IgA and IgE. Practically, IgM class RF with specificity to human IgG (Fc) is the
most useful prognostic marker of RA. The clinical significance of RF determinations consists in differentiation between
rheumatoid arthritis, in which RF of modified IgM class have been demonstrated in the serum of approximately 80% of the
cases examined and rheumatic fever, in which RF are almost always absent. The agglutination test is most frequently
used because of its greater sensitivity and simplicity.
RHELAX-RF is a latex agglutination slide test for detection of rheumatoid factors of the IgM class.

PRESENTATION
REF 10410050 10410100 10410005
Latex 50 tests 2 x 50 tests 5 ml
Control + 0.4 ml 0.4 ml -
Control - 0.4 ml 0.4 ml -
Six circle glass slide 1 1 -
Sample droppers 50 100 -
Mixing stick ladder 2 4 -
Rubber teat 1 2 -
Pack insert 1 1 1

REAGENTS
1. RHELAX-RF reagent (latex): A uniform suspension of polystyrene latex particles coated with suitably modified Fc
fraction of IgG. The reagent is standardised to detect 10 IU/ml of RF or more. The standardization of detection limit
of Rhelax RF is traceable to the W.H.O., 1st International Reference Preparation of Rheumatoid Arthritis Serum.
2. Positive control, reactive with the RHELAX-RF reagent.
3. Negative control, non-reactive with the RHELAX-RF reagent.

Each batch of reagents undergoes rigorous quality control at various stages of manufacture for its specificity, sensitivity
and performance.

REAGENT STORAGE AND STABILITY

a) Store the reagents at 2-80C. DO NOT FREEZE.
b) The shelf life of the reagent is as per the expiry date mentioned on the reagent vial label. Do not use reagents after the
expiry date.

PRINCIPLE
RHELAX-RF slide test for detection of rheumatoid factors is based on the principle of agglutination. The test specimen
is mixed with RHELAX-RF latex reagent and allowed to react. If RF is present within detectable levels then a visible
agglutination is observed. If RF is absent below detectable levels then no agglutination is observed.

NOTE
1. In vitro diagnostic reagent for laboratory and professional use only. Not for medicinal use.
2. The reagents that are derived from human source have been tested for HBsAg and Anti-HIV antibodies and are
found to be non-reactive. However handle the material as if infectious.
3. Reagent contains 0.1% Sodium Azide as preservative. Avoid contact with skin and mucosa. On disposal flush with
large quantities of water.
4. The reagent can be damaged due to microbial contamination or on exposure to extreme temperatures. It is
recommended that the performance of the reagent be verified with the positive and negative controls provided with
the kit.
5. Shake the RHELAX-RF latex reagent well before use to disperse the latex particles uniformly and improve test
readability.
6. Only a clean and dry glass slide must be used. Clean the slide with distilled water and wipe dry.
7. Accessories provided with the kit only must be used for optimum results.
8. Do not use damaged or leaking reagents.

SPECIMEN COLLECTION AND PREPARATION

No special preparation of the patient is required prior to specimen collection by approved techniques. Only serum must be
used for testing. Should a delay in testing occur, store the sample at 2-80C. Samples can be stored for upto a week. Do not
use hemolysed serum.

ADDITIONAL MATERIAL REQUIRED

Stop watch, Test tubes, A high intensity direct light source, Isotonic saline.
Note: For RHELAX-RF (REF: 10410005): - sample dispensing pipette and mixing sticks would be required additionally.

TEST PROCEDURE
Bring reagent and samples to room temperature before use.

Qualitative Method
1. Pipette one drop (40 l) of serum onto the glass slide using the disposable pipette provided with kit.
2. Add one drop of RHELAX-RF latex reagent to the drop of serum on the slide. Do not let the dropper tip touch the
liquid on the slide.
3. Using a mixing stick, mix the serum and RHELAX-RF latex reagent uniformly over the entire circle.
4. Immediately start a stopwatch. Rock the slide gently, back and forth, observing for agglutination macroscopically at
two minutes.

Semi Quantitative Method

1. Using isotonic saline prepare serial dilutions of the serum sample positive in the qualitative method 1:2, 1:4, 1:8,
1:16, 1:32, 1:64 and so on.
2. Pipette one drop (40l) of each dilution of the serum sample onto separate reaction circles.
3. Add one drop of RHELAX-RF latex reagent to each drop of the diluted serum sample on the slide. Do not let the
dropper tip touch the liquid on the slide.
4. Using a mixing stick, mix the sample and the latex reagent uniformly over the entire circle.
5. Immediately start a stopwatch. Rock the slide gently, back and forth, observing for agglutination macroscopically at
two minutes.

INTERPRETATION OF RESULTS
Qualitative Method
Agglutination is a positive test result and indicates the presence of rheumatoid factors in the test specimen.
No agglutination is a negative test result and indicates the absence of rheumatoid factors in the test specimen.

Semi Quantitative Method

Agglutination in the highest serum dilution corresponds to the approximate amount of rheumatoid factors in IU/ml present
in the test specimen.
To calculate the RF in IU/ml, use the following formula.
RF (IU/ml) = S x D
Where, S = Sensitivity of the reagent i.e. 10 IU/ml.
D = Highest dilution of serum showing agglutination.

REMARKS
1. Markedly lipemic, hemolysed and contaminated serum samples could produce non-specific results.
2. Use of plasma rather than serum can lead to false positive results.
3. Do not read results beyond two minutes.
4. Rheumatoid factors are not exclusively found in rheumatoid arthritis but sometimes in syphilis, systemic lupus
erythematosus, hepatitis, hypergammaglobulinemia also.
5. It is recommended that results of the test should be correlated with clinical findings to arrive at the final diagnosis.
6. The RHELAX-RF reagent is free from prozone effect at RF levels between 10 IU/ml to 2300 IU/ml of RF
concentration.
7. RHELAX-RF reagent is sensitive to the presence of IgM RF with heterogenous specificity.

PERFORMANCE CHARACTERISTICS
l The performance characteristics of RHELAX RF were evaluated using known positive and negative samples. The
known samples were validated using other commercial manufacturers latex slide test reagent having similar
performance characteristics.
RHELAX-RF
Total
+ VE - VE
RF + ve samples 16 16 0
RF - ve samples 70 0 70
86 16 70
l Sensitivity: 100% l Specificity: 100%

l Repeatability and reproducibility (inter-assay and inter-lot) were evaluated on a number of RF negative and RF
positive samples. No variations were found in the outcome of different tests.

WARRANTY
This product is designed to perform as described on the label and the package insert. The manufacturer disclaims any
implied warranty of use and sale for any other purpose.

BIBLIOGRAPHY
1. Cecil R. L., Nichols E. E., Am. J. Med. Sci., 181: 12 (1931).
2. Heller G., Jacobson S.A., Koloday M. H., Kammerer M. H., J. Immunol., 72 : 66 (1954).
3. Singer J. M., Bull. Rheum. Dis., 24: 762 (1974).
4. Clinical Laboratory Diagnostics, Edited by Lothar Thomas, M.D., 1st Ed., 1998, TH-Books Verlagsgesellschaft mbH,
Frankfurt, Germany.
5. Data on File: Tulip Diagnostics (P) Ltd.

0
8C
0
Contains sufficient
Store at 2-8 C Manufacturer for <n> tests
20C

Consult
Use by Instructions CONTROL + Positive control
for use

Date of
Manufacture REF Catalogue
Number CONTROL - Negative control

In vitro
LOT Batch Number IVD Diagnostic Device REAGENT Description of reagent

Xn
Harmful if swallowed
Do not breathe vapour
II

Authorised
This way up EC REP Representative
If swallowed, seek medical advice immediately
and show this container or label
NaN3, R22 Avoid release to the environment. Refer to special instructions.
S23-46-61