Figure 4

RF reacts with citrullinated fibrinogen in the presence of ACPAs. Graphs show serological response to citrullinated IgG1 Fc (a) or fibrinogen (b) when incubated with ACPA + sera (step 1), followed by incubation with the indicated RA patient sera-subtypes (step 2), determined by sequential ELISA. The same experiments were repeated using ACPA + sera digested with pepsin in step 1 (dACPA + RF−) for citrullinated IgG1 Fc (c) or fibrinogen (d). Data represent three independent experiments. ****p < 0.0001; ***p < 0.001; **p < 0.01; *p < 0.05.