Diagnostic usefulness of a third-generation anti-cyclic citrulline antibody test in patients with recent-onset polyarthritis

José Luis Caro-Oleas 1 , 1 , Antonio Fernández-Suárez 2 , 2 , Sonsoles Reneses Cesteros 3 , 3 , Carmen Porrino 4 , 4 , Antonio Núñez-Roldán 5 , 5 ,  and Ingeborg Wichmann Schlipf 6 , 6
  • 1 Department of Immunology, University Hospital Virgen del Rocío, Sevilla, Spain
  • 2 Department of Biotechnology, Hospital Alto Guadalquivir, Andújar, Spain
  • 3 Department of Rheumatology, University Hospital Virgen del Rocío, Sevilla, Spain
  • 4 Biotechnology Area, Empresa Pública Hospital de Poniente de Almería, El Ejido, Spain
  • 5 Department of Immunology, University Hospital Virgen del Rocío, Sevilla, Spain
  • 6 Department of Immunology, University Hospital Virgen del Rocío, Sevilla, Spain


Background: The high specificity of anti-cyclic citrullinated peptide antibodies (anti-CCP) helps substantially in the diagnosis of rheumatoid arthritis (RA), combined with classical markers such as rheumatoid factor (RF). The recent introduction of third-generation methods (anti-CCP3) for anti-CCP detection could further improve diagnostic efficiency. The aim of this study was to determinate the diagnostic efficiency (sensitivity and specificity) of anti-CCP using a new anti-CCP3 method and to compare it with the previous second-generation method (anti-CCP2).

Methods: Anti-CCP were studied in sera of 234 patients with recent-onset polyarthritis (ROP) (age ≥16 years; evolution time ≥4 weeks ≤1 year; 2 or more inflamed joints, without drug therapy). After 1 year, 124 patients were diagnosed with RA (American College of Rheumatology criteria). Two ELISAs, an anti-CCP2 and an anti-CCP3, were performed.

Results: The best sensitivity according to receiver operating characteristic curves was 51.5% and 54.8% for anti-CCP3 and anti-CCP2, with a specificity of 96.2% and 98.1%, respectively (optimal cutoffs 14.2 and 18.7 U/mL). Significant correlations were obtained (p<0.001) when the methods were compared to each other and to RF.

Conclusions: Testing with both types of anti-CCP kit is highly specific for the presence of RA. In our ROP group, anti-CCP2 and anti-CCP3 exhibited similar diagnostic efficiency.

Clin Chem Lab Med 2007;45:1396–401.

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Clinical Chemistry and Laboratory Medicine ( CCLM) publishes articles on novel teaching and training methods applicable to laboratory medicine. CCLM welcomes contributions on the progress in fundamental and applied research and cutting-edge clinical laboratory medicine. It is one of the leading journals in the field, with an impact factor of over three. CCLM is the official journal of nine national clinical societies and associated with EFLM.