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 ,  und 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 3. CCLM is the official journal of 9 national clinical societies and associated with EFLM.