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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

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Volume 48, Issue 6


Diagnostic performance of anti-citrullinated peptide antibodies for the diagnosis of rheumatoid arthritis: the relevance of likelihood ratios

Donatello Pietrapertosa / Barbara Tolusso / Elisa Gremese / Maria Concetta Papalia / Silvia Laura Bosello / Giusy Peluso / Luca Petricca / Alessandro Michelutti / Francesca Faustini / Anna Laura Fedele / Gianfranco Ferraccioli
Published Online: 2010-03-19 | DOI: https://doi.org/10.1515/CCLM.2010.152


Background: The goal of our study was to evaluate the diagnostic performance of the anti-cyclic citrullinated peptide 2 (anti-CCP2) assay in patients with autoimmune and inflammatory disorders.

Methods: We tested the specificity and sensitivity of anti-CCP2 antibodies measured by ELISA in 787 patients with rheumatoid arthritis (RA), 1024 patients with other autoimmune/inflammatory rheumatic disease and 401 subjects without autoimmune rheumatic disease. The optimal cut-off value was defined as the value with the highest diagnostic accuracy (receiver operating characteristic curve analysis). Interval-specific likelihood ratios (LRs) were calculated for each range bounded by defined anti-CCP2 values.

Results: To distinguish between patients with RA and controls, the cut-off value with the highest diagnostic accuracy for anti-CCP2 was 2.8 U/mL. Comparing the optimal cut-off value for anti-CCP2 to that recommended by the manufacturer (5.0 U/mL), an increase in prevalence between the proportions of test-positive patients was found for RA, undifferentiated connective tissue disease and undifferentiated arthritis. Evaluating interval-specific LRs for the selected ranges bound by two anti-CCP2 values, in RA and diseased controls, the LRs were 0.40 for values <5.0 U/mL, 6.66 for 5.0–15.0 U/mL, 27.01 for 15.1–30.0 U/mL and 28.89 for >30.0 U/mL.

Conclusions: The cut-off value of 2.8 U/mL for anti-CCP2 has the highest diagnostic accuracy. A value of anti-CCP2 >15 U/mL is associated with an increase in the likelihood of RA disease.

Clin Chem Lab Med 2010;48:829–34.

Keywords: anti-CCP2; cut-off; diagnostic accuracy; likelihood ratios; rheumatoid arthritis

About the article

Corresponding author: Gianfranco Ferraccioli, MD, Professor of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Via Moscati 31, 00168, Rome, Italy

Received: 2009-11-24

Accepted: 2010-01-17

Published Online: 2010-03-19

Published in Print: 2010-06-01

Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 48, Issue 6, Pages 829–834, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2010.152.

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