RESEARCH - Diagnostic and predictive value of anti-CCP antibodies in RA: a systemic literature review

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ls of the Rheumatic Diseases 2006;65:845-851

© 2006 by BMJ Publishing Group Ltd & European League Against Rheumatism

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REVIEW

Diagnostic and predictive value of anti-cyclic citrullinated protein

antibodies in rheumatoid arthritis: a systematic literature review

J Avouac, L Gossec and M Dougados

René Descartes University, Medicine Faculty; APHP Cochin Hospital,

Rheumatology B Department, Paris, France

Correspondence to:

Professor M Dougados

Rhumatologie B, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014

Paris, France; maxime.dougados@...

Accepted 2 April 2006

ABSTRACT

Objective: To evaluate the two generations of anti-cyclic citrullinated

protein (CCP) antibodies as a diagnostic marker of rheumatoid arthritis (RA)

and as a predictor of future development of RA in healthy subjects and in

patients with early undifferentiated arthritis.

Methods: A systematic analysis of the literature published between 1999 and

February 2006 was conducted. Data were collected on the sensitivity and

specificity of the two generations of anti-CCP antibodies for diagnosing RA

and predicting future development of the disease.

Results: Among 107 studies initially identified, 68 had interpretable data

and were analysed. Diagnostic properties were assessed in 58 studies: mean

(SD) sensitivity was 53 (10)% (range 41-68) and 68 (15)% (range 39-94) for

anti-CCP1 and anti-CCP2, respectively; mean (SD) specificity was 96 (3)%

(range 90-99) and 95 (5)% (range 81-100) for anti-CCP1 and anti-CCP2,

respectively. Predictive properties were assessed in 14 studies; odds ratio

(95% confidence interval) of anti-CCP1 and anti-CCP2 for the future

development of RA were 20 (14 to 31) and 25 (18 to 35), respectively, among

patients with early undifferentiated arthritis and 64.5 (8.5 to 489) and 28

(8 to 95), respectively, among healthy subjects.

Conclusion: Sensitivity of the second generation of anti-CCP is close to

that of rheumatoid factor, with a higher specificity, for distinguishing RA

from other rheumatic diseases. Moreover, anti-CCP antibodies appear to be

highly predictive of the future development of RA in both healthy subjects

and patients with undifferentiated arthritis.

http://ard.bmjjournals.com/cgi/content/abstract/65/7/845

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