Diagnostic and clinical value of anti-CCP antibodies compared with RF isotypes in RA

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Ann Rheum Dis. 2004 Sep;63(9):1079-84. Related Articles, Links

Diagnostic and clinical value of anti-cyclic citrullinated peptide

antibodies compared with rheumatoid factor isotypes in rheumatoid

arthritis.

Vallbracht I, Rieber J, Oppermann M, Forger F, Siebert U, Helmke K.

Krankenhaus Munchen-Bogenhausen, Clinical Immunology/Rheumatology,

Englschalkinger Str 77, 81925 Munich, Germany.

Klaus.Helmke@...

OBJECTIVE: To assess the additional diagnostic and clinical value of the

second test generation of anti-cyclic citrullinated peptide antibodies

(CCP2) compared with rheumatoid factor isotypes (IgG-RF, IgA-RF, IgM-RF)

in patients with rheumatoid arthritis. METHODS: This was a prospective

study on 715 patients: rheumatoid arthritis (n = 295), degenerative or

other inflammatory joint disease (n = 163), connective tissue disease or

vasculitis (n = 103), and healthy controls (n = 154). Sera from each

subject were tested for CCP2 and RF isotypes by enzyme linked

immunosorbent assay (ELISA). Agreement with clinical indices such as

disease activity, joint destruction, disease duration, and other

laboratory tests was assessed. Sensitivity and specificity of the tests

were evaluated taking the clinical diagnosis as the gold standard.

RESULTS: Highest sensitivity was found for IgM-RF (66.4%) and CCP

(64.4%). Highest specificity was achieved by CCP (97.1%) and IgG-RF

(91.0%). In rheumatoid patients with high disease activity or severe

joint damage, CCP was more often present (81.4% and 83.6%) than all RF

isotypes. Of special diagnostic value was the detection of positive CCP

in 34.5% of all patients with rheumatoid arthritis when all measured RF

isotypes (IgG-RF, IgA-RF, and IgM- RF) were negative.

CONCLUSIONS: As a screening method for rheumatoid arthritis the IgM-RF

and the CCP assays are superior to other RF isotypes. Positivity in the

highly specific CCP ELISA supports the diagnosis of rheumatoid

arthritis. CCP proved to be a powerful diagnostic tool, especially in

ambiguous cases or RF negative patients with rheumatoid arthritis.

PMID: 15308516

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