SUMMARYRheumatoid factor (RF) production has been demonstrated during infections, mcluding itifectious exacerbations of cystic fibrosis (CT). The aim of this study was to evaluate the relationship of RF production to infection, and examine the mechanisms involved. Serial peripheral blood mononuclear ccll(PBMC) cultures with nieasuremenl of spontaneous production of IgM RF, IgA RF, total IgM and IgA, and measurement of serum levels of immune complexes were earned out during exacerbations of CF. The percentage of B cells expressing CDS was examined in a second cohort of acutely infected CF patients, and related to IgM RF production. IgM RF productioti was significantly elevated duritig acute itifeclion compared with convalescence (/'<005). stable CF subjects (P<0005) and normal controls (P<00.^). IgM RF production did not correlate with total IgM production in the majority of patients, but was closely related to circulating immune complex levels in 8/10 subjects. IgA RF production did not increase significantly during infection, and did not correlate with total IgA or IgM RFproduction.or with circulating immune complex levels. CD5' B cells were not increased in the CF group, and the percentage of CD5 ' B cells did not correlate with IgM RF synthesis. These observations suggest that RF production during infection is specifically induced, possibly by immune complex autoimmunization. and is not simply the result of polyelonal B cell activation. Different patterns of IgM RF and IgA RF synthesis suggest different mechanisms of induction.