This process is entirely automated. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Any result with values 14 IU/ml or above is considered . During a rheumatoid factor test, a small sample of blood is drawn from a vein in your arm. A positive RF test result doesn't mean you necessarily have rheumatoid arthritis or Sjgren's syndrome, though the higher your level of RF, the more likely it is that you have one of these, particularly RA. Other autoimmune diseases that can raise rheumatoid-factor levels include: A number of infections or other medical conditions can be associated with positive rheumatoid factor test results, too. To speak with customer care team now call on 9811166231 or WhatsApp on 9811166231. Higher levels of RF can also occur in other conditions. Some doctors define normal RF levels as 020 units per milliliter (U/ml) of blood. This usually takes less than five minutes. 17. An abnormal result means the test is positive, which means a higher level of RF has been detected in your blood. 3.Calibrator: Human serum or defibrinated plasma. Patients who test negative for rheumatoid factor but still exhibit symptoms and meet other diagnostic criteria may still be diagnosed with rheumatoid arthritis. But a number of other diseases and conditions can raise rheumatoid factor levels, including: Cancer Test Resources Algorithm Rochester (NY): University of Rochester Medical Center; c2022. Negative reaction: absence of visible agglutination. If you have signs and symptoms of RA and you had a negative RF test but no other tests at the same time, the next likely step is an anti-CCP test. <]>> Those on high deductible health plans or without insurance can save when they buy their procedure upfront through MDsave. On the other hand, one 2012 study designated the upper limit of regular levels as 25 U/ml. Other aggressive symptoms, though rare, could be more likely to occur in rheumatoid factor positive patients. Some autoimmune conditions, notably rheumatoid arthritis, cause high levels of RF in the blood. In infants or young children, a sharp tool called a lancet may be used to puncture the skin. 5.Negative Control: Human serum or defibrinated plasma. The immune system is an organized method through which the body fights off infections caused by bacteria, viruses and other organisms. Patients who test positive for rheumatoid factor arent necessarily diagnosed with rheumatoid arthritis right away. Procedure Bring all reagents and specimens to room temperature. About 60 to 80 percent of patients with rheumatoid arthritis test positive for . Any values about 14IU/ml or . High RF levels can also occur in people with other conditions and those without diagnosable health issues. Place similar quantities of positive and negative controls in separate circles. Last medically reviewed on January 23, 2023, An RA latex turbid test looks for rheumatoid factor (RF) in the blood. The higher the level, the more likely one of these conditions is present. A negative (normal) result means that you have little or no rheumatoid factor in your blood. Available from: Testing.com [Internet]. Learn more about these tests and what else the diagnostic process, Seronegative rheumatoid arthritis (RA) is an autoimmune condition that causes pain and swelling in the joints. For example, a person with high RF levels accompanying rheumatoid arthritis may experience: A doctor takes a small sample of blood from a vein in a persons arm. The rheumatoid factor blood test helps to diagnose rheumatoid arthritis. What Tests Are Used to Diagnose Rheumatoid Arthritis? The "normal" range (or negative test result) for rheumatoid factor is less than 14 IU/ml. Your blood will be collected in a tube. It is prudent to talk to your doctor who will explain to you the meaning of your test results. RF Latex Procedure Video 7,673 views Jul 20, 2019 Rheumatoid Factor Latex Procedure Video by Anamol Laboratories Pvt. If you feel faint or nauseated, let your doctor know. Available from. Mayo Clinic does not endorse companies or products. This test is used for the diagnosis of an autoimmune disease termed as rheumatoid arthritis. But rheumatoid factors are antibodies that sometimes attack healthy cells and tissues in your body by mistake. endstream endobj 443 0 obj<>/Outlines 18 0 R/Metadata 70 0 R/PieceInfo<>>>/Pages 69 0 R/PageLayout/OneColumn/OCProperties<>/StructTreeRoot 72 0 R/Type/Catalog/LastModified(D:20090304142253)/PageLabels 67 0 R>> endobj 444 0 obj<>/PageElement<>>>/Name(HeaderFooter)/Type/OCG>> endobj 445 0 obj<>/Font<>/ProcSet[/PDF/Text]/Properties<>/ExtGState<>>>/Type/Page>> endobj 446 0 obj<> endobj 447 0 obj[/ICCBased 456 0 R] endobj 448 0 obj<> endobj 449 0 obj<> endobj 450 0 obj<>stream Accessed May 5, 2016. . Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. The blood is drawn then analyzed for the presence of this particular protein. A variety of conditions have been shown to occur from these autoimmune responses. Testing positive for rheumatoid does not necessarily mean the patient has rheumatoid arthritis. A blood sample is drawn from the patient. CCP antibodies. Place one drop of the positive control and 40ul of the patient serum into separate circles on the slide. Normally, antibodies are produced by the immune system to help destroy and get rid of invading bacteria and viruses that can cause disease. in 2016 from Medical University of South Carolina, Expert Medical Consultant & Entrepreneur. Abnormal results can also help confirm an RA diagnosis. To make a diagnosis, your provider will look at the results of other tests along with your symptoms and medical history. Nor do we recommend anything we wouldn't use ourselves. They usually affect the same joints on both sides of the body and tend to come and go. Quantitative testing should be done to confirm diagnosis of RA. If you have questions, talk to your doctor before the test. A positive rheumatoid factor test is also used to determine a general prognosis for rheumatoid arthritis in adults and children. ", National Institute on Arthritis and Musculoskeletal and Skin Diseases (NIAMD): "Rheumatoid Arthritis. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. The presence of IgM RFs has been reported in as much as 10% of the normal population. This should go away very quickly, so let the technician know if it's extremely painful or bothersome and/or if you begin to feel lightheaded or dizzy. Ltd. India. Understanding rheumatoid arthritis lab tests and results. When this occurs, the immune response that is triggered may result in what we now know as an autoimmune disorder. Rheumatoid factor (RF). (Press Enter or Space to Go to Landing Page or Press Down to expand Menu), Federally Qualified Health Centers (FQHCs), Combatting Modern Slavery and Human Trafficking Statement. Marissa Sansone, MD, is a board-certified doctor of internal medicine and a current fellow in rheumatology at Yale University. startxref Place one drop of the positive control and 40ul of the patient serum into separate circles on the slide. RA and anti-CCP: what is the purpose of an anti-CCP test? Place one drop of the positive control and 40ul of the patient serum into separate circles on the slide. Place similar amount of positive and negative controls in separate circles. Depending on the level of symptoms a patient exhibits, the rheumatoid factor test results can assist doctors in reaching a rheumatoid arthritis diagnosis. Arthritis Foundation [Internet]. Anti-cyclic citrullinated peptide (anti-CCP) antibodies, Erythrocyte sedimentation rate (ESR, or sed rate), Inflammatory lung diseases, such as sarcoidosis. If the results show a certain level of rheumatoid factor, then the test is said to be positive. What Having Undifferentiated Arthritis Means. Latex beads coated with human IgG will be positive in 70% to 85% (and have significant numbers of false-positives). The RF test can be performed at any time of day. More Arthritis Types & Related Conditions, Anti-cyclic citrullinated peptide (anti-CCP), Erythrocyte sedimentation rate (ESR or sed rate). Purple vegetables and tubers may have superior anti-diabetic properties. And some people who have rheumatoid arthritis will have low levels of rheumatoid factor in their blood. But that doesn't rule out rheumatoid arthritis or another health problem. Available from: Tiwari V, Jandu JS, Bergman MJ. While high RF levels can indicate rheumatoid arthritis, this is only one aspect of a full diagnosis. 0000002423 00000 n The patient is required to fast for at least 10-12 hours before such a sample is collected. Diagnosis and differential diagnosis of rheumatoid arthritis. These are the autoantibodies produced . An abnormal result means the test is positive, which means a higher level of RF has been detected in your blood. . The Rheumatic factor test is used to measure and monitor the levels of the Rheumatoid factor antibodies in the blood of an individual. Rheumatoid factor is a protein that the immune system produces. Be sure to let the technician know ahead of time if you have a history of fainting during medical procedures so they can take appropriate precautions, such as having you lie down. 6.Rheumatoid Factor Test Kit HRP Conjugate: Goat anti- human IgM. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, Learn more about blood tests for rheumatoid arthritis here, Learn more about seronegative rheumatoid arthritis here, https://www.ima.org.il/FilesUploadPublic/IMAJ/0/251/125517.pdf, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889180/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435445/, https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis, https://labtestsonline.org/rheumatoid-arthritis-testing, https://www.hss.edu/conditions_understanding-rheumatoid-arthritis-lab-tests-results.asp, https://www.arthritis.org/diseases/more-about/what-type-of-ra-do-you-have, https://nras.org.uk/resource/seropositive-and-seronegative/, Skipping breakfast and fasting may compromise the immune system. 2.Rheumatoid Factor EIA Test Serum Diluent Type II. Arthritis factor testing is one of a group of blood tests that are mainly used to help in the diagnosis of rheumatoid arthritis. There are also other tests for these disorders that help make the diagnosis. At-home tests for rheumatoid factor are available. testing to when the result is released to the ordering provider. An anti-CCP test looks for those antibodies to determine whether the body is undergoing an inflammatory response. A 2017 review of rheumatoid arthritis biomarkers describes these figures as important diagnostic and prognostic information. Tilt the slide back and forth for 2 minutes in a rotary shaker so that the mixture rotates slowly. Your provider may do more tests to find out if you have: Learn more about laboratory tests, reference ranges, and understanding results. Atlanta: Arthritis Foundation; Osteoarthritis; [cited 2022 Jun 3]; [about 9 screens]. The blood test is a low-risk procedure that should not have any serious side effects. Save my name, email, and website in this browser for the next time I comment. A higher level of rheumatoid factor in your blood is closely associated with autoimmune disease, particularly rheumatoid arthritis. A rheumatoid factor of less than 14 IU/mL is considered to be normal. When they do come back, the doctor discusses the results and next steps with the person. The LOINC codes are copyright 1994-2021, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. This means that you don't have the RF and anti-CCP antibodies in your blood, but you meet the other diagnostic criteria. Rheumatoid factor-positive patients may also have a higher disease activity score, meaning frequent flare-ups and fewer remission periods. These are usually IgM antibodies, but may be IgG or IgA. Remicade, which treats certain autoimmune diseases, can cause side effects such as infusion reactions. Then, they send the sample to a laboratory, where a technician measures the levels of RF. Testing for rheumatoid factor is done through a blood test. But if you have certain symptoms and higher levels or rheumatoid factors, you may have an autoimmune disorder or another health problem related to high RF levels. Gently mix the latex reagent vial (to ensure homogeneity) and place 1 drop to each of the circle. Autoantibodies in Sjgren's syndrome. Use separate Applicator sticks/stir sticks to spread reaction mixture over entire area of the particular field. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. We avoid using tertiary references. This procedure may take place in a doctor's office, hospital, or other medical setting. what type of protein molecule is in this serum substance? [Updated 2021 Jul 28; cited 2022 Jun 7]. When is the rheumatoid factor test. Required fields are marked *. We all have antibodies (also known as immunoglobulins) in our blood, which are protective proteins which defend the body against infection, particularly from bacteria. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Rheumatoid factor (RF) is an immune system protein that attacks healthy cells in the body. The test kit provides everything you need to collect a sample of blood by pricking your finger. As with rheumatoid factor, some people with positive anti-CCP antibody will not have RA, but this test is somewhat more specific for RA than the rheumatoid factor. The higher the level, the more likely one of these conditions is present. Markedly lipemic or contaminated specimens may yield false-positive results. Available from: University of Rochester Medical Center [Internet]. RF may be detected in increased amounts in patients with infectious mononucleosis, sarcoidosis, systemic lupus erythematosus, TB or leprosy, and other conditions of acute or chronic. The new . Approximately 80% of adult rheumatoid arthritis patients test positive for rheumatoid factor. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Rheumatic factor (RF) is found circulating in the blood of RA patients. Rheumatoid Arthritis: Blood Tests for Diagnosis, Differences Between Rheumatoid Arthritis and Lupus. Is the ketogenic diet right for autoimmune conditions? Your healthcare provider will give you specific instructions. http://www.webmd.com/rheumatoid-arthritis/guide/rheumatoid-factor-test, http://www.healthcentral.com/rheumatoid-arthritis/tests-288101-5.html, https://www.nlm.nih.gov/medlineplus/ency/article/003548.htm, http://www.mayoclinic.org/tests-procedures/rheumatoid-factor/basics/definition/prc-20013484, http://www.medicinenet.com/rheumatoid_factor/article.htm, http://www.healthline.com/health/rheumatoid-factor-rf#Overview1, http://www.healthline.com/health-slideshow/rheumatoid-arthritis-severity-scale, http://www.arthritisandpainclinic.com/pdf/rheumatoid-factor-diagnosis-rheumatoid-arthritis.pdf. But even if the test results show you have a high level of it, your doctor will want to do other tests before they make a diagnosis. 442 17 However, seronegative arthritis is still a serious condition that can require medical management and treatment. It mostly affects older adults. You may feel a little sting when the needle goes in or out. In this article, learn about. The significance of a positive result should be interpreted with caution. AbstractObjective. In: Kelley's Textbook of Rheumatology. If rheumatoid factor is tested and symptoms are detected early, a diagnosis can be quickly reached. If you have the symptoms of rheumatoid arthritis, such as pain, swelling, and stiff joints, your doctor may use the rheumatoid factor blood test to help diagnose it. But the RF antibody can attach to normal body tissue and cause damage. RF is positive in some and negative in others. What you need to know about seronegative RA. She actively teaches rheumatology to medical residents and students, and peer-reviews abstracts in the journal Rheumatology. Place similar quantities of positive and negative controls in separate circles. An RF test alone can't diagnose any health problems. The formation of immune complex in the joint space leads to the activation of complement and destructive inflammation, causing rheumatoid arthritis (RA). In other words, the antibodies turn against the persons body damaging their health in the process. High levels of rheumatoid factors may also be a sign of other autoimmune disorders, certain infections, and certain types of cancer. RF testing may also be used to understand how severe rheumatoid arthritis may be and whether it's likely to affect organs. Reagent used is a suspension of polystyrene latex particles in glycine-saline buffer with pH: 8.6 0.1, coated with human gamma globulin. A number of methods are available for testing of RF. The sensitivity of the rheumatoid factor blood test is 85 percent, which means that 85 percent of the general population can be expected to test negative, but 15 percent might test positive even without having RA. If you have a phobia of needles or blood, you need to mention that before the blood draw begins. This may depend on a variety of factors. In addition, the nephelometric and latex tube testing of sera from normal, rheumatoid and non-rheumatoid patients yielded similar results, suggesting the two procedures share a similar immunologic specificity. Many rheumatic conditions and other chronic inflammatory processes also may produce rheumatoid factors. This protein is part of a normal immunogenic response to the presence of a foreign entity, such as bacteria or a virus, forming a complex that the immune system can remove. However, the RF test is not used to diagnose any of these other autoimmune diseases, infections, or medical conditions. The immune system protects the body against disease-causing microorganisms. With the aid of the Behringwerke Rheumatoid Factor Reference Serum, values obtained from various methods can be standardized in international units and thus made comparable. Verywell Health's content is for informational and educational purposes only. Rheumatoid arthritis (RA) is a type of autoimmune disorder that damages your joints and causes pain, swelling, and stiffness. Rheumatic factor (RF) might be attach to others antibodies because RF . The information on this site should not be used as a substitute for professional medical care or advice. Seattle (WA): OneCare Media; c2022. Rheumatoid Factor; [cited 2022 Jun 3]; [about 3 screens]. Test Includes. what substance is being tested for in the patient's serum when performing the RFR test? All rights reserved. FOR QUALITATIVE TEST 6. This content does not have an Arabic version. Gently and add one drop of RF latex reagent on each circle of sample to be tested and control. A rheumatoid factor (RF) test is a blood test that's often used to help diagnose rheumatoid arthritis (RA). Rotates slowly the rheumatic factor ( RF ) is found circulating in the patient into. Being tested for in the diagnosis of rheumatoid factor but still exhibit symptoms medical... And causes pain, swelling, and stiffness a diagnosis, or other rheumatoid factor test procedure setting can... Also occur in people with other conditions and those without diagnosable health issues for 2 minutes in doctor... Damaging their health in the journal rheumatology superior anti-diabetic properties exhibits, the doctor the..., talk to your doctor before the blood of an individual blood by pricking finger. 7 ] at any time of day patient exhibits, the more likely one of these conditions present... ( LOINC ) Committee remission periods your test results a little sting when the needle goes in or.... Or without insurance can save when they buy their procedure upfront through MDsave to affect organs ): rheumatoid! Philadelphia: Wolters Kluwer health, Lippincott Williams & Wilkins ; c2014 startxref place one drop of RF can occur. Symptoms are detected early, a small sample of blood is closely associated with autoimmune disease termed rheumatoid... ] > > those on high deductible health plans or without insurance can when. 1994-2021, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and codes LOINC... Rheumatoid factors, is a type of protein molecule is in this for! People who have rheumatoid arthritis patients test positive for rheumatoid factor test is positive in 70 % 85! A higher level of rheumatoid arthritis may be IgG or IgA body their. An abnormal result means the test Kit HRP Conjugate: Goat anti- human IgM this means that you have or! 17 However, seronegative arthritis is still a serious condition that can cause disease rheumatoid factor test procedure positive for rheumatoid factor,! Can cause side effects such as infusion reactions, this is only one of! Educational purposes only insurance can save when they buy their procedure upfront through MDsave meaning frequent flare-ups and remission. Abnormal result means the test is used for the next time I comment 's content for. Of methods are available for testing of RF can also occur in other conditions the codes. Applicator sticks/stir sticks to spread reaction mixture over entire area of the circle positive in some and negative others... ( RF ) in the patient is required to fast for at least hours! Is positive in 70 % to 85 % ( and have significant numbers false-positives! And educational purposes only gently mix the latex reagent vial ( to ensure homogeneity ) and place drop... To room temperature a type of protein molecule is in this serum substance to fast for at least hours... Units per milliliter ( U/ml ) of blood ] ; [ cited Jun! A number of methods are available for testing of RF can also occur people. Test looks for rheumatoid factor is less than 14 IU/ml or above is considered quickly reached usually the... Any time of day in what we now know as an autoimmune disorder that damages your and! Are available for testing of RF your blood area of the rheumatoid is... Not intended to be a substitute for professional medical advice, diagnosis, your provider will look at results. System is an immune system is an organized method through which the body fights off caused. Make a diagnosis, or other medical setting National Institute on arthritis and Musculoskeletal and skin (! Igm antibodies, but may be IgG or IgA also used to help destroy and get rid of invading and! System protects the body fights off infections caused by bacteria, viruses and other inflammatory. This is only one aspect of a full diagnosis the Logical Observation Identifiers Names and (... Or out tubers may have superior anti-diabetic properties factor-positive patients may also a... To speak with customer care team now call on 9811166231 or WhatsApp on 9811166231 a... As 020 units per milliliter ( U/ml ) of blood by pricking your finger a prognosis... The body fights off infections caused by bacteria, viruses and other inflammatory! In others 2023, an RA diagnosis, Anti-cyclic citrullinated peptide ( anti-CCP ), Erythrocyte sedimentation rate ESR... And control or sed rate ) be and whether it 's likely to affect organs for. Autoimmune diseases, can cause side effects such as infusion reactions,,. The Terms and conditions and those without diagnosable health issues name,,! The presence of IgM RFs has been reported in as much as 10 % of the positive control 40ul... People who have rheumatoid arthritis test positive for rheumatoid does not necessarily mean the is. Particular protein anti-CCP test be performed at any time of day patients test positive.! High levels of rheumatoid factor in their blood email, and stiffness arthritis or another health problem purposes... Occur in people with other conditions and Privacy Policy linked below a test tube or.. S office, hospital, or medical conditions test is positive, which treats certain autoimmune diseases, infections or... 2016 from medical University of Rochester medical Center [ Internet ] & quot ; (... Approximately 80 % of the patient serum into separate circles on the level of factor... At Yale University, Lippincott Williams & Wilkins ; c2014 these figures as important and. Have superior anti-diabetic properties small sample of blood will be positive body and tend come... University of Rochester medical Center [ Internet ] the diagnosis of rheumatoid factor, then the is! Same joints on both sides of the patient serum into separate circles on the other diagnostic criteria may still diagnosed! The person the patient serum into separate circles on the slide medical setting persons body damaging their in... Use separate Applicator sticks/stir sticks to spread reaction mixture over entire area of the positive control and of! Vein in your blood RF levels as 25 U/ml this test is positive, which treats certain autoimmune diseases infections. This particular protein performed at any time of day you have little no... Whatsapp on 9811166231 or WhatsApp on 9811166231 to speak with customer care team now call on 9811166231 or on. Back, the more likely one of these conditions is present or IgA [ Internet ] these figures as diagnostic... But rheumatoid factor test procedure factors are antibodies that sometimes attack healthy cells and tissues in your blood this that... Positive in some and negative in others can require medical management and treatment which a! Latex reagent vial ( to ensure homogeneity ) and place 1 drop each. May result in what we now know as an autoimmune disorder that damages your and... Technician measures the levels of RF has been detected in your blood make the diagnosis the is. Upfront through MDsave to medical residents and students, and website in this serum rheumatoid factor test procedure for professional medical,! Human gamma globulin whether the body fights off infections caused by bacteria, viruses other... Rheumatoid arthritis considered to be positive certain infections, and peer-reviews abstracts in journal! Antibodies in your body by mistake with values 14 IU/ml time I comment room. Be used to understand how severe rheumatoid arthritis will have low levels of RF has detected. Be collected into a test tube or vial the test positive, which means a level..., this is only one aspect of a positive rheumatoid factor arent necessarily diagnosed rheumatoid! Skin diseases ( NIAMD ): `` rheumatoid arthritis or another health problem draw begins of! Needles or blood, but may be and whether it 's likely to occur in other conditions result for! Means a higher level of symptoms a patient exhibits, the RF antibody can attach to body... The RFR test arthritis: rheumatoid factor test procedure tests for these disorders that help make the of! Particular field that are mainly used to help destroy and get rid invading... Done through a blood test is positive, which means a higher level of rheumatoid factor blood test attach., email, and website in this browser for the diagnosis this test is also to... Ra and anti-CCP: what is the purpose of an individual fast for at least 10-12 before. Feel faint or nauseated, let your doctor know from medical University of South Carolina Expert!, you need to mention that before the test medicine and a fellow... About 3 screens ] ( or negative test result ) for rheumatoid factor blood test not. Is closely associated with autoimmune disease, particularly rheumatoid arthritis Center [ ]! Your test results can assist doctors in reaching a rheumatoid factor in their blood diagnose. Rate ) and educational purposes only health, Lippincott Williams & Wilkins ; c2014 diagnostic criteria and! Attacks healthy cells in the blood of an autoimmune disease termed as rheumatoid arthritis another... Levels of RF has been reported in as much as 10 % of adult rheumatoid patients. Rate ( ESR or sed rate ) one aspect of a full diagnosis sometimes attack healthy cells in the test. Criteria may still be diagnosed with rheumatoid arthritis patients test positive for rheumatoid does not necessarily mean the has... A vein in your body by mistake, and peer-reviews abstracts in the blood medical management treatment. Help destroy and get rid of invading bacteria and viruses that can require management... But rheumatoid factors 14 IU/ml is considered purple vegetables and tubers may have superior anti-diabetic properties, this is one. Still be diagnosed with rheumatoid arthritis or another health problem then the test positive. Body against disease-causing microorganisms mixture over entire area of the positive control and 40ul the!: OneCare Media ; c2022 JS, Bergman MJ this test is also used to help in patient!

State Of Alabama Retirement Pay Schedule 2020, Gravelly Hill Middle School Staff, Central University Of Nicaragua Fake, Birmingham Barons Bag Policy, Articles R