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EXTENDED REPORT |
Department of Medicine, Division of Rheumatology, Immunology and Allergy Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA.
Correspondence to:
Correspondence to:
Professor P H Schur, Brigham and Women’s Hospital, Rheumatology and Immunology, 75 Francis Street, PBB-2, Boston, MA 02115, USA;
pschur{at}partners.org
Objectives: To determine the frequency of antibodies to cyclic citrullinated peptides (CCP) in a group of patients with a diversity of rheumatic diseases.
Methods: 249 consecutive sera from an arthritis clinic sent for rheumatology testing were selected for testing with the anti-CCP2 assays and for the presence of rheumatoid factor (RF). Patient charts were reviewed for demographic information, clinical diagnosis, radiographic information, and other laboratory data.
Results: The sensitivity and specificity of anti-CCP reactivity for the diagnosis of rheumatoid arthritis (RA) were 66.0% and 90.4%, respectively. This compared with the sensitivity and specificity of RF for RA at 71.6% and 80.3%. Furthermore, 10/29 (34%) RF- patients with RA demonstrated reactivity to CCP. The presence of either anti-CCP or RF increased testing sensitivity for diagnosis of RA to 81.4%; the presence of both RF and anti-CCP demonstrated a testing specificity similar to that of anti-CCP reactivity alone for the diagnosis of RA (91.1%).
Conclusions: The detection of anti-CCP is useful for the diagnosis of RA, in fact even more so than RF, because of its higher specificity.
Keywords: rheumatoid arthritis; diagnostic tests; rheumatoid factor; anticitrulline; joint erosion
Abbreviations: ACR, American College of Rheumatology; AKA, antikeratin antibodies; APF, antiperinuclear factor; CCP, cyclic citrullinated peptides; IF, immunofluorescent; JRA, juvenile rheumatoid arthritis; OA, osteoarthritis; NPV, negative predictive value; PPV, positive predictive value; PsA, psoriatic arthritis; RA, rheumatoid arthritis; RF, rheumatoid factor; ROC, receiver operating characteristic; SLE, systemic lupus erythematosus; SSC, sensitised sheep cell
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