RESEARCH - Role of anti-CCP in the diagnosis of early RF-negative suspected RA: is it worthwhile to order the test?

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J Clin Rheumatol. 2006 Aug;12(4):172-5.

Role of anticyclic citrullinated peptide in the diagnosis of early

rheumatoid factor-negative suspected rheumatoid arthritis: is it worthwhile

to order the test?

Chanre Diagnostic Laboratory, Chanre Rheumatology & Immunology Center &

Research, Bangalore.

BACKGROUND: Anticyclic citrullinated peptide (anti-CCP) is a relatively new

serologic marker, which has been proposed for use in the diagnosis of

rheumatoid arthritis (RA) and is said to be a highly specific. OBJECTIVE:

The aim of the study was to evaluate the role of anti-CCP in a South Indian

population of patients with suspected RA in the early stages when rheumatoid

factor is negative and clinical presentation is atypical. METHODS: Patients

with early inflammatory arthritis who were rheumatoid factor-negative were

investigated for anti-CCP. The patients were reviewed by a rheumatologist

and, based on American College of Rheumatology criteria, were diagnosed with

RA or another disease after a follow-up period of 3 to 6 months. The

rheumatologist was blinded to the results of the anti-CCP. The sensitivity

and specificity of anti-CCP was estimated in comparison to follow up and

final clinical diagnosis. The anti-CCP was estimated by the enzyme-linked

immunosorbent assay method using a commercially available kit (Euroimmune).

RESULTS: One hundred forty-three patients with a mean age of 47.1 years and

a male to female ratio of 0.22:1 were recruited for the study. Thirty cases

were positive for anti-CCP and 41 cases were finally diagnosed RA.

Twenty-six of the 30 anti-CCP-positive patients were diagnosed with RA.

Thus, the sensitivity of anti-CCP in our institution for the diagnosis of RA

in the early stage in a group of rheumatoid factor-negative patients with

atypical presentation was 63.4% with 36.6% false-negatives and the

specificity was 96.1% with 3.9% false-positive cases. The positive

predictive value of anti-CCP was 86.7% and the negative predictive value was

86.7%. Kappa statistic of agreement, chi McNemar test, indicated anti-CCP to

be an efficient test in this study population.

CONCLUSION: Anti-CCP is a useful and highly specific but not absolutely

specific or sensitive test to detect RA and supplements rheumatoid factor in

the presence of a strong clinical suspicion.

PMID: 16891919

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16891919

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