• rheumatoid factor
• rheumatoid arthritis
• autoantibodies

Erik Waaler was born at Hamar, Norway on 22 February 1903 and died in Bergen on 3 March 1997 (figure 1). He graduated from the Medical Faculty, University of Oslo, in 1927. Thereafter, he spent some time as intern at Hamar Hospital, as well as general practitioner. Waaler started his scientific career in 1930 at the Army Laboratory for Bacteriology in Oslo. There he got training in bacteriology and carried out the studies which led to his doctoral dissertation, ‘On the Dissociation of the Dysentry Bacillus’, with creation as Doctor Medicinae in 1935. In the mean time, he worked as resident in internal medicine for 2 years at Aker’s Hospital and the University Hospital in Oslo, Rikshopitalet. In 1936, he obtained a university scholarship in clinical bacteriology, and he spent part of that time at Columbia University in New York.

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Figure 1

Portrait of Erik Waaler.

Probably the most exciting moment in Waaler’s academic life took place in 1937 when he was working at Ullevål Hospital, Department of Pathology in Oslo. On 10 December, he was analysing Wassermann’s reaction as part of the routine work and observed in one test serum that sheep blood cells agglutinated. It turned out that this patient had joint deformities. He reproduced this finding in sera from other patients with joint symptoms. However, many of these sera tested negative, which may be related to the fact that in the late 1930s, proper classification of inflammatory joint diseases was not established. Furthermore, Oslo did not have any separate department of rheumatology and special rheumatism hospitals did not yet exist in 1937. Waaler called the factor AA-factor, ‘agglutination-activating factor’ (figure 2), which subsequently was coined as rheumatoid factor by Robert Pike.1

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Figure 2

The AA-factor and Waaler-Rose test.

A similar discovery was made almost 10 years later by Rose and colleagues in 1948.2 Some of the coauthors of this publication had previously listened to a presentation by Waaler about the AA-factor. However, Rose did not accept that he and Waaler discovered the same factor, and it took a while before Waaler’s discovery became known and recognised in the USA. Professor Robert Pike in May 1949 wrote a letter to Waaler, which recognises him as the first discoverer of rheumatoid factor.

Later on, Professor Ragan gave a lecture about immunological reactions in the Heberden Society in London, where he also acknowledges Waaler his deserved recognition as the first discoverer of rheumatoid factor. This lecture was subsequently published in the Annals of the Rheumatic Diseases in 1959.3 It also belongs to the story that it is believed that Rose never responded to letters from Waaler and maybe they ever met.

In 1938, when Waaler was appointed prosektor at Ullevål Hospital in Oslo, he switched over to the specialty, which later became his major passion, namely, pathology. In 1941, he was appointed prosektor at Dr Med FG Gades patologisk-anatomiske laboratorium in Bergen, subsequently the Gade Institute, Department of Pathology, and in 1948 as the chair of pathology, pathological anatomy and forensic medicine at the University of Bergen.

The young doctor who came to Bergen in 1941 during the occupation of Norway had an unusually broad training in internal medicine, bacteriology and pathology. Subsequently, it turned out that he also had an extraordinary working capacity. After the war, an explosive, and in part chaotic, period of planning, projecting and constructive work awaited the medical and academic life in Bergen. The University of Bergen, including a medical faculty, was established in 1948, where Waaler became the first dean. Later, he was elected rector of the University for two periods and was in this function, instrumental for supporting the establishment of the Broegelmann Research Laboratory in 1957, after a major donation to the University. This became an important platform where Waaler’s immunological studies on rheumatoid factor was followed up by Olav Tønder and Jacob B Natvig in the the late 1950s and early 1960s.

One published paper alone, a congress report in 1939,4 made Waaler’s name world famous, namely, ‘A factor in human serum activating the specific agglutination of sheep blood corpuscles’, subsequently published as a full paper in 1940.5 This was the original description of the rheumatoid factor test. The laboratory test has been mostly referred to as the Waaler-Rose reaction (figure 2) and is still of importance in rheumatology. High levels of rheumatoid factor in the blood are most often associated with autoimmune diseases, such as rheumatoid arthritis and Sjögren's syndrome. However, rheumatoid factor may be detected in some healthy individuals, and patients with autoimmune diseases sometimes have normal levels of rheumatoid factor.