Rheumatoid factor is a key biomarker in the diagnosis and management of rheumatoid arthritis and other rheumatic diseases. However, its non-specific nature presents significant diagnostic challenges. An elevated titre of rheumatoid factor is commonly seen in rheumatoid arthritis patients, but it can also be positive in other autoimmune diseases, chronic infections, healthy individuals and especially the elderly, creating a real challenge for the clinicians. On the other hand, up to 30% of rheumatoid arthritis patients are seronegative, resulting in a diagnostic delay and inappropriate management. For this reason, clinicians should not rely solely on the results of rheumatoid factor as there may be a misclassification of other conditions such as osteoarthritis or gout as rheumatoid arthritis. Advances in diagnostic criteria and the introduction of anti-cyclic citrullinated peptide antibodies reduced reliance on the rheumatoid factor as the former test is more specific than the latter. Clinicians should integrate rheumatoid factor results with clinical findings and other diagnostic tools to ensure accurate diagnosis and optimal patient care.