RESEARCH - Easy and Accurate Diagnosis of Rheumatoid Arthritis Using Anti-Cyclic Citrullinated Peptide 2 Antibody, Swollen Joint Count, and C-Reactive Protein/Rheumatoid

[Guest guest]

J Rheumatol. 2008 Jan 15 [Epub ahead of print]

Easy and Accurate Diagnosis of Rheumatoid Arthritis Using Anti-Cyclic

Citrullinated Peptide 2 Antibody, Swollen Joint Count, and C-Reactive

Protein/Rheumatoid Factor.

Yamane T, Hashiramoto A, Tanaka Y, Tsumiyama K, Miura Y, Shiozawa K, Chihara

K, Shiozawa S.

From the Department of Rheumatology, Kobe University Graduate School of

Medicine; Rheumatic Diseases Division, Kobe University Hospital; Division of

Endocrinology/Metabolism, Neurology, and Hematology/Oncology, Department of

Clinical Molecular Medicine, Kobe University Graduate School of Medicine,

Kobe; and Rheumatic Disease Centre, Konan Kakogawa Hospital, Kakogawa,

Japan.

OBJECTIVE: To determine an easy-to-use diagnostic criterion for early

rheumatoid arthritis (RA) that may be useful for general physicians, using

anti-cyclic citrullinated peptide (CCP) antibody. METHODS: We prospectively

studied 435 patients who first visited the hospital with arthritic symptoms

within 24 months, including 264 visitors within 6 months. The diagnosis was

made on their first visit by examination and laboratory tests including

anti-CCP antibodies, rheumatoid factor (RF) and C-reactive protein (CRP),

and radiograph. RESULTS: The diagnostic specificity and positive predictive

value (PPV) of anti-CCP2 assay were 94.9% and 87.8%, respectively, and those

of anti-CCP2 plus RF were 96.9% and 90.9% for the patients who first visited

having morning stiffness, arthralgia, and/or joint swelling within 3 months

from onset (n = 165). For the patients who first visited later, but within

24 months from onset (n = 260), the diagnostic specificity and PPV were

extremely high, 98.7% and 95.5%, when anti-CCP2 assay was coevaluated with

RF, CRP, and more than 3 swollen joints. Respective combinations of

anti-CCP2 assay plus either 2 of 3 measures were also highly specific.

CONCLUSION: A diagnostic criterion including anti-CCP2 assay in combination

with RF, CRP, and/or swollen joints is less sensitive but highly specific,

and accurately predicts future development of RA among those with arthritic

symptoms who first consulted doctors within 2 years after onset. It should

be highly useful for the general physician without special techniques or

devices.

PMID: 18203327

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=18

203327

Not an MD