Anti-CCP Negative and ACR Criteria Positive -- Should We Treat?

[Guest guest]

Anti-Cyclic Citrullinated Peptides-Negative and American College of

Rheumatology Criteria-Positive. Should Disease-Modifying Anti-

Rheumatic Drugs and Nonsteroidal Anti-Inflammatory Drugs Continue?



Question

If an anti-cyclic citrullinated peptides (CCP) negative result is

seen in a patient with clinically and American College of

Rheumatology criteria-positive rheumatoid arthritis, is it reasonable

to continue treatment with disease-modifying anti-rheumatic drugs and

nonsteroidal anti-inflammatory drugs?

Dr. Nandakumar



Response from Arthur Kavanaugh, MD

University of California at San Diego, Division of Rheumatology,

Allergy, and Immunology, La Jolla, California.



There has recently been substantial and growing interest in the use

of antibodies to CCP (anti-CCP) as a diagnostic test in patients with

rheumatoid arthritis (RA).[1] Similar to rheumatoid factor (RF), the

anti-CCP can be of value in the diagnosis of patients with RA. The

present generation of anti-CCP tests has sufficient sensitivity for

the diagnosis of RA that approximates that of RF, and it is more

specific. Tests for RF, by definition, are positive in 5% of the

general population; moreover, the prevalence of positive test results

tends to increase with age, and may reach 15% or more among older

persons. This is especially true of women. By contrast, although

there are a few exceptions (such as psoriatic arthritis, where the

prevalence of anti-CCP antibodies is about 7%), the prevalence of

positive anti-CCP antibody tests in the general population is less

than 5%.

In the case presented in this question, the patient is RF positive,

but lacks anti-CCP antibodies. This raises an interesting issue, more

relevant perhaps to the prognostic value of these tests. For many

years, it has been realized that patients seropositive for RF tended

to have more aggressive disease compared to those lacking RF. It

appears that anti-CCP antibodies have similar prognostic relevance.

In most cases, the bulk of results were concurrent for these tests

(ie, either RF+ and anti-CCP+, or RF- and anti-CCP-). In the cases in

which the test results are discordant, as is true here, the patient

should still be considered to be seropositive in relation to

therapeutic implications. This would be the case also if the patient

was RF- but anti-CCP+. In cases such as this, and based on other

clinical considerations, aggressive treatment to control signs and

symptoms of disease would be indicated.



Posted 06/05/2006

http://www.medscape.com/viewarticle/533283?rss