Diagnostic Value of Anti-CCP in Patients with Rheumatoid Arthritis Based on American College of Rheumatology Criteria

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Rheumatology, School of Medicine. Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident, Department of Internal Medicine, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis specified by some antibodies. Although the most relevant antibody is rheumatoid factor (RF), it has little sensitivity and specificity for diagnosis of RA. Other groups of antibodies that are produced against the citrullinated epitopes have been proved to be more specific for diagnosing RA. Anti-CCP testing based on ELISA assay is the most effective test for detecting anti-filaggrin antibodies. Positive values of anti-CCP antibody a few years before the clinical signs and symptoms of RA along with high concentrations of this antibody in the synovial fluid increase the probability of citrollination in the pathogenesis of the disease. A combination of anti-CCP and RF would increase the sensitivity of both tests. Most previous studies have used RF as a gold standard for evaluating the diagnostic value of anti-CCP. However, RF is known to have a low sensitivity and specificity. Therefore, we decided to realistically evaluate the diagnostic value of anti-CCP based on American college of rheumatology (ACR) criteria as a gold standard.Methods This was a descriptive study to evaluate the diagnostic value on 49 RA patients and 49 individuals with other rheumatic diseases. Blood samples were taken to measure erythrocyte sedimentation rate (ESR), RF, anti-CCP. Disease activity was then determined by DAS28. Data analysis was performed by 2 × 2 tables, chi-square test and receiver operating characteristic (ROC) curve for trade-off points. We used SPSS15. Findings: Data analysis showed anti-CCP to have a sensitivity of 71%, a specificity of 80%, a positive predictive value of 78%, a negative predictive value of 74%, a positive likelihood ratio of 3.55 and a negative likelihood ratio of 0.36. In this study, anti-CCP and RF had a statistically significant correlation (P < 0.001).Conclusion: Anti-CCP is a test with a high predictive value for diagnosing RA. 

Keywords

References

  1. van Boekel MA, Vossenaar ER, van den Hoogen FH, van Venrooij WJ. Autoantibody systems in rheumatoid arthritis: specificity, sensitivity and diagnostic value. Arthritis Res 2002; 4(2): 87-93.
  2. Harrison TR, Fauci AS, raunwald E, Isselbacher KJ, Wilson JD, artin JB, et al. Harrison's Principles of Internal Medicin. 14th ed. New York: Mcgraw-Hill; 1997. p. 1933.
  3. Vincent C, Serre G, Lapeyre F, Fournie B, Ayrolles C, Fournie A, et al. High diagnostic value in rheumatoid arthritis of antibodies to the stratum corneum of rat oesophagus epithelium, so-called 'antikeratin antibodies'. Ann Rheum Dis 1989; 48(9): 712-22.
  4. Nienhuis RL, Mandema E. A new serum factor in patients with rheumatoid arthritis; the antiperinuclear factor. Ann Rheum Dis 1964; 23: 302-5.
  5. Schellekens GA, Visser H, de Jong BA, van den Hoogen FH, Hazes JM, Breedveld FC, et al. The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Arthritis Rheum 2000; 43(1): 155-63.
  6. Young BJ, Mallya RK, Leslie RD, Clark CJ, Hamblin TJ. Anti-keratin antibodies in rheumatoid arthritis. Br Med J 1979; 2(6182): 97-9.
  7. Bizzaro N, Mazzanti G, Tonutti E, Villalta D, Tozzoli R. Diagnostic accuracy of the anti-citrulline antibody assay for rheumatoid arthritis. Clin Chem 2001; 47(6): 1089-93.
  8. Schellekens GA, de Jong BA, van den Hoogen FH, van de Putte LB, van Venrooij WJ. Citrulline is an essential constituent of antigenic determinants recognized by rheumatoid arthritis-specific autoantibodies. J Clin Invest 1998; 101(1): 273-81.
  9. van Venrooij WJ, Pruijn GJ. Citrullination: a small change for a protein with great consequences for rheumatoid arthritis. Arthritis Res 2000; 2(4): 249-51.
  10. Kroot EJ, de Jong BA, van Leeuwen MA, Swinkels H, van den Hoogen FH, van't Hof M, et al. The prognostic value of anti-cyclic citrullinated peptide antibody in patients with recent-onset rheumatoid arthritis. Arthritis Rheum 2000; 43(8): 1831-5.
  11. Vasishta A. Diagnosing early-onset rheumatoid arthritis: the role of anti-CCP antibodies. Am Clin Lab 2002; 21(7): 34-6.
  12. Lab Test Online. Cyclic Citrullinated Peptide (CCP): A New Serum Marker for Rheumatoid Arthritis [Online] 2003 Jan. [cited 2004 Feb 4]; Available from: URL: http://labtestsonline.org/understanding/analytes/
  13. CCP/tab/test.
  14. Zendman AJ, van Venrooij WJ, Pruijn GJ. Use and significance of anti-CCP autoantibodies in rheumatoid arthritis. Rheumatology (Oxford) 2006;45(1): 20-5.
  15. Munoz-Fernandez S, Alvarez-Doforno R, Gonzalez-Tarrio JM, Balsa A, Richi P, Fontan G, et al. Antiperinuclear factor as a prognostic marker in rheumatoid arthritis. J Rheumatol 1999; 26(12): 2572-7.
  16. Miyamura T, Watanabe H, Takahama S, Sonomoto K, Nakamura M, Ando H, et al. [Diagnostic utility of anti-cyclic citrullinated peptide antibody in early rheumatoid arthritis]. Nihon Rinsho Meneki Gakkai Kaishi 2009; 32(2): 102-9.
  17. Gupta R, Thabah MM, Aneja R, Kumar A, Varghese T, Chandrasenan PJ. Usefulness of anti -CCP antibodies in rheumatic diseases in Indian patients. Indian J Med Sci 2009; 63(3): 92-100.
  18. Heidari B, Firouzjahi A, Heidari P, Hajian K. The prevalence and diagnostic performance of anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: the predictive and discriminative ability of serum antibody level in recognizing rheumatoid arthritis. Ann Saudi Med 2009; 29(6): 467-70.
  19. Poormoghim H, Shekarabi M, Golnari P, Yazdipoor N, Nozari B, Farjam Nia A, et al. Evaluation of the diagnostic accuracy of anti-citrulline antibody in rheumatoid arthritis patients and its comparison with other rheumatic disorders and normal individuals. Razi Journal of Medical Sciences 2009; 16(62): 89-98.
  20. Heidari B, Lotfi Z, Firouzjahi RA, Heidari P. Comparing the diagnostic values of Anti-cyclic citrullinated peptide antibodies and rheumatoid factor for rheumatoid arthritis. Journal of The Faculty of Medicine Shaheed Beheshti University of Medical Sciences 2010; 33(3): 156-61.
  21. Salesi M, Farajzadegan Z, Karimifar M, Mottaghi P, Sayed Bonakdar Z, Karimzadeh H. Disease activity index and its association with serum concentration of anti-cyclic citrullinated peptide 1 (anti-CCP1) in patients with rheumatoid arthritis. Razi Journal of Medical Sciences 2010; 17(84): 15-21.
  22. Kavanaugh A, Matteson E, Cush J. Hotline. American College of Rheumatology; 2003.
  23. O'Dell JR. Treating rheumatoid arthritis early: a window of opportunity? Arthritis Rheum 2002; 46(2): 283-5.
  24. Jokar M, Mahmoodi M, Hesari S, Sobhani. Diagnostic value of anti-cyclic citrullinated peptide antibodies in patients with rheumatoid arthritis. Modarres Journal of Medical Sciences 2008; 10(3-4): 59-64.
Journal of Isfahan Medical School
Volume 29, Issue 165 - Serial Number 165
November and December 2012
Pages 2221-2229

Files

History

  • Receive Date: 24 March 2011
  • Revise Date: 02 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics