The influence of genetic factors on the expression of CD5+ B lymphocytes and their relationship to a broad spectrum of autoantibodies was investigated in a study of 12 patients with rheumatoid arthritis (RA) and 52 of their healthy first-degree relatives. The proportion of CD5+ B cells was significantly higher in RA patients (mean +/- SEM 23.9 +/- 2.7%) compared with that in their relatives (18.3 +/- 1.1%, P less than 0.05) and compared with that in a group of healthy control subjects (16.1 +/- 1.8%; P less than 0.05). Much more striking, however, were the high levels of CD5+ B cells found in the patients and their relatives in 5 of the families studied. Increases in total immunoglobulin levels and autoantibody levels were frequently observed in RA patients (approximately 20-40%) and their relatives (approximately 10-20%). Furthermore, a statistically significant correlation (P less than 0.01) between IgM rheumatoid factor and the percentage of B lymphocytes expressing CD5 was observed.