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

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Published Online First: 30 January 2008. doi:10.1136/ard.2007.082339

ls of the Rheumatic Diseases 2008;67:1557-1561

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CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Anti-cyclic citrullinated peptide revised criteria for the

classification of rheumatoid arthritis

K P Liao , K L Batra , L Chibnik , P H Schur , K H Costenbader

Division of Rheumatology, Immunology and Allergy, Department of

Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Objective: The 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 centre with

rheumatoid factor (RF) and anti-CCP tested simultaneously between 1

January and 30 June 2004 and reviewed their medical records for the

ACR criteria, rheumatologists' diagnoses, RF and anti-CCP. We revised

the ACR criteria in two ways: (a) adding anti-CCP, and ( 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 positive and 14% were anti-CCP positive 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.

Conclusions: 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 the classification of subjects for RA in clinical

studies.

http://ard.bmj.com/cgi/content/abstract/67/11/1557?etoc

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