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. 2003 Sep;62(9):870–874. doi: 10.1136/ard.62.9.870

Clinical utility of the anti-CCP assay in patients with rheumatic diseases

D Lee 1, P Schur 1
PMCID: PMC1754666  PMID: 12922961

Abstract

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.

Full Text

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Figure 1.

Figure 1

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ROC curves for anti-CCP (A) and RF (B) assays. Individual datapoints are represented as small squares. A best fit curve was generated by non-linear regression calculation. Arrows mark the cut off values used for this study.

Figure 2.

Figure 2

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CCP reactivity in rheumatic disease subsets. Shown are the levels of anti-CCP reactivity in sera from patients with labelled rheumatic diagnoses. Closed squares RF-; open squares RF+.

Figure 3.

Figure 3

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RF v CCP values. The values in units of RF and CCP activity in 214 rheumatic disease patients are shown. Correlation coefficient (R)=0.34.

Figure 4.

Figure 4

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Correlation of anti-CCP activity and radiographic joint destruction. The percentage of patients with anti-CCP reactivity and RF relative to the presence of erosions in patients with available radiographs (n=129) is shown.

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