The Diagnostic Value of Anti-Cyclic Citrullinated Peptide Antibodies (anti-CCP) in Patients with Rheumatoid Arthritis
A cross-sectional study was carried out to analyze the prevalence of anti-CCP antibodies and IgM RF in the sera of 160 randomly selected patients from the Rheumatology Department: 60 with RA, 50 with other rheumatic diseases (non-RA), 50 healthy controls (HC). The mean age of the group was 50.06+/-11.9 years. There were 141 females (88.1%) and 19 males (11.9%). RA patients fulfilled the revised ACR criteria. The mean duration of the disease was 82.4 months. Anti-CCP ELISA kit and IgM RF Latex test were used. The mean anti-CCP values were as follows: RA 60.4+/-57.6, non-RA 2.1+/-3.6, HC 1.3 +/-0.4 U/mL. Respectively, the mean values of IgM RF were: RA 515.8+/-525, non-RA 102+/-294, HC 15+/-57.5. Forty out of 60 (66.6%) RA patients were anti-CCP positive. Forty one out of 60 (68.3%) RA patients were positive for IgM RF. As expected, anti-CCP showed comparable sensitivity (66.8% vs. 68.3%) and higher specificity (98% vs. 87%) than IgM RF, at optimal cut-off values. The presence of either anti-CCP or IgM RF increased the testing sensitivity for the diagnosis of RA to 76.6%. AUC was greater for anti-CCP than for IgM RF (0.92 vs. 0.82).
-Oleas, Servicio de
Inmunologı́a, Edificio de Laboratorios, 3a planta, Hospital
Universitario Virgen del Rocı́o, Avenida Manuel Siurot s/n,
41013, Sevilla, Spain
Phone: q34-955013231, Fax: q34-955013221,
(anti-CCP); rheumatoid arthritis; rheumatoid factor;
third-generation anti-CCP ELISA.
Rheumatoid arthritis (RA) is a systemic autoimmune
disease characterized by chronic inflammation of
peripheral joints, leading to severe destruction. This
disease affects between 0.5% and 1% of
antibodies for very early rheumatoid arthritis. J Rheumatol 2006; 33 (12): 2390-7. Damjanovska V, Atanasovska V, Gruev T. The diagnostic value of anti-cycliccitrullinatedpeptideantibodies (anti-CCP) in patients with rheumatoid arthritis. Journal of Medical Biochemistry 2007; 26 (4): 285-288. Spasovski D, Gruev T, Marina N, Calovski J, Perčinkova S, Rajčevska Lj Osmani B, Cakalaroski K. The diagnostic value of the second generation anti-CCP test in rheumatoid arthritis. Journal of Medical Biochemistry 2008; 27 (1): 52-58. Spasovski D, Gruev T, Marina N, Calovski J
(CRP), anti-cycliccitrullinatedpeptideantibody (anti-
CCP), rheumatoid factor (RF) and TNFα, as posible factors
implicated in the pathogenesis of RA.
Methods. We investigated sera from 60 RA and 20 healthy
control, during 3 years, for anti-CCP(second and third
generation), FR and TNFα using ELISA-INOVA kit and for
CRP by Mancini technique.
Results. Anti-CCP antibodies were found to be positive in
60% of cases and FR at 75% of patients. We have found that
serum anti-CCP and IgA RF are present for a median of 2-3
years prior to the onset of symptoms in patients who
were renewed in order to detect the disease earlier . In the newest criteria set serological findings were weighted. About 60%–70% of the patients with RA have elevated levels of either rheumatoid factor (RF) or anti-cycliccitrullinatedpeptideantibodies (anti-CCP), or both [5, 6]. IgG antibodies directed towards a synthetic citrullinated type II collagen peptide were detectable in 40% of the cases in a cohort of early RA patients. These autoantibodies are specifically bound to the citrullinated triple helical collagen type II amino acid residues 359–369 [7
were based on combinations of the following index terms: rheumatoid arthritis; CCP; anti-CCP antibodies; anti-CCP antibody; anti-cyclic citrullinated peptide antibodies and anti-cyclic citrullinated peptide antibody; second-generation assays of anti-cycliccitrullinatedpeptideantibodies; anti-CCP-2 and anti-CCP3; and CCP-2 and CCP-3. We also reviewed the reference lists of retrieved studies and review articles. Study selection Two reviewers independently scanned abstracts that met the inclusion criteria. We included studies that evaluated the utility of assaying
peptideantibodies (anti-CCP) are a serological marker of rheumatoid arthritis and also have a prognostic value
for more aggressive disease.
This study aimed to investigate vitamin D status on anti-CCP and rheumatoid factor serum levels in RA patients.
Cross-sectional study. January, February and March were considered winter, April, May and June, were evaluated as spring,
summer months were July, August and September and finally, autumn included October, November and December. Anti-
CCP over 60 U/mL and rheumatoid factor (RF) above 15 IU/mL were considered
24 % with breast tumor. Patients were examined for the presence of autoantibodies:
rheumatoid factor (RF) and anti-cycliccitrullinatedpeptideantibody (anti-CCP) test was performed by enzyme-linked
immunosorbent assay (ELISA); anti-nuclear antibodies (ANA) were tested by indirect immunofluorescence on Hep-2
cells; immunoblotting technique was used to detect autoantibodies to anti-neuronal antibodies (ANNA).
RF was detected in 31% of patients with paraneoplastic rheumatic syndrome and in 20% of control group; it should
be noted that 45% of patients with
) depending on anti-cycliccitrullinatedpeptideantibody (anti-CCP) status may be helpful
in distinguishing different aetiopathologies and in predicting
course of disease (1). HLA-DRB1 shared epitope and
peptidylarginine deiminase type 4 (PADI4) genotype, which
have been implicated in anti-CCP generation and protein
citrullination, respectively, are assumed to be associated with
susceptibility to RA (2). Aims: To elucidate whether PADI4
affects clinical characteristics of RA, and whether it modulates
the effect of anti-CCP on clinical course. Methods: In 373 RA