RESEARCH - Anti-CCP revised criteria for the classification of RA

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Ann Rheum Dis. 2008 Jan 30 [Epub ahead of print]

Anti-CCP revised criteria for the classification of rheumatoid arthritis.

Liao KP, Batra KL, Chibnik L, Schur PH, Costenbader KH.

Brigham and Women's Hospital, United States.

OBJECTIVE: Classification of rheumatoid arthritis (RA) is increasingly

important as new therapies can halt the disease in its early stages.

Antibodies to cyclic citrullinated peptides (anti-CCP) are widely used

for RA diagnosis, but are not in the 1987 American College of

Rheumatology (ACR) Criteria for RA Classification. We developed and

tested the performance characteristics of new criteria for RA

classification, incorporating anti-CCP. METHODS: We identified all

subjects seen in our Arthritis Center with rheumatoid factor (RF) and

anti-CCP tested simultaneously between January 1 and June 30, 2004 and

reviewed their medical records for the ACR criteria, rheumatologists'

diagnoses, RF and anti-CCP. We revised the ACR criteria in two ways:

(1) adding anti-CCP, (2) replacing rheumatoid nodules and erosions

with anti-CCP (CCP 6 criteria). We compared sensitivity and

specificity of all criteria, in all subjects and in subjects with

arthritis symptoms < 6 months. RESULTS: Medical records of 292

subjects were analysed: mean age was 54 years, 82% were women, and

mean symptom duration was 4.1 years. 17% were RF+ and 14% were

anti-CCP+ at initial testing. 78 (27%) had definite RA per treating

rheumatologist at latest follow-up. The CCP 6 criteria increased

sensitivity for RA classification for all subjects regardless of

symptom duration: 74% vs. 51% for ACR criteria with a loss in

specificity (81% vs. 91%). Sensitivity was greatly improved in

subjects with symptoms < 6 months: 25% vs. 63% for ACR criteria with a

decrease in specificity. CONCLUSION: The CCP 6 criteria improved upon

the sensitivity of the ACR criteria, most remarkably for subjects with

symptoms < 6 months and could be used for classification of subjects

for RA in clinical studies.

PMID: 18234714

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=182347\

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