RESEARCH - Predictive value of anti-CCP antibodies in patients with very early inflammatory arthritis

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Journal of Rheumatology

February 2005

Predictive Value of Antibodies to Cyclic Citrullinated Peptide in Patients

with Very Early Inflammatory Arthritis

KARIM RAZA, MIKE BREESE, PETER NIGHTINGALE, KANTA KUMAR, TANYA POTTER, DAVID

M. CARRUTHERS, DEVA SITUNAYAKE, CAROLINE GORDON, CHRISTOPHER D. BUCKLEY,

MIKE SALMON, and GEORGE D. KITAS

ABSTRACT.

Objective. To study the prognostic value of antibodies to cyclic

citrullinated peptide (anti-CCP) and rheumatoid factor (RF), alone and in

combination, in patients with very early synovitis.

Methods. A cross-sectional study was performed in patients with established

inflammatory and noninflammatory disease to validate the assay in our unit

and confirm previously reported sensitivities and specificities of anti-CCP

antibodies. Subsequently, patients with synovitis of ? 3 months' duration

were followed for 72 weeks and the ability of anti-CCP antibodies and RF to

predict the development of rheumatoid arthritis (RA) and persistent

inflammatory arthritis was assessed.

Results. One hundred twenty-four patients were assessed in the initial

cross-sectional study. Anti-CCP antibodies and RF were detected by ELISA in

only 4% of patients with non-RA inflammatory disease and in no patient with

noninflammatory disease. Ninety-six patients with very early synovitis were

assessed longitudinally. In these patients with early arthritis, the

combination of anti-CCP antibodies and RF had a specificity, positive

predictive value (PPV), sensitivity, and negative predictive value (NPV) for

a diagnosis of RA of 100%, 100%, 58%, and 88%, respectively. The

specificity, PPV, sensitivity, and NPV of this antibody combination for the

development of persistent disease-fulfilling classification criteria for RA

were 97%, 86%, 63%, and 91%, respectively.

Conclusion. In patients with synovitis of < 3 months' duration, a

combination of anti-CCP antibodies and RF has a high specificity and PPV for

the development of persistent RA. This autoantibody combination can be used

to identify patients with disease destined to develop RA who may be

appropriate for very early intervention. (J Rheumatol 2005;32:231-8)

http://www.jrheum.com/abstracts05/231.html

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