[Early diagnosis of rheumatoid arthritis with a test based upon a specific antigen: cyclic citrullinated peptide].
In patients with rheumatoid arthritis (RA), joint erosions occur at a very early stage of the disease before clinical symptoms can be detected. Early treatment with currently available antirheumatic drugs may stop or delay the development of such erosions. A simple and specific diagnostic test is needed for treatment to be initiated at an early stage. The specificity of the routinely used rheumatoid factor (RF) test is too low for that purpose. A novel autoantibody, directed to citrullinated antigens in the synovium, seems to provide a new starting point. These citrullinated autoantigens (e.g. fibrin) are specifically present in inflamed synovia and the antibodies for these are locally produced. The autoantibodies can be detected in the blood of the patients with RA years before the first clinical signs are manifest, and high titres appear to correlate strongly with erosive disease. The test for cyclic citrullinated peptide, which has recently become available, has a specificity of 98-99% and a sensitivity of 75-80%.
van Venrooij
W J
WJ
Katholieke Universiteit, faculteit Natuurwetenschappen, Wiskunde en Informatica, afd. Biochemie, Postbus 9101, 6500 HB Nijmegen. w.vanvenrooij@ncmls.kun.nl
van de Putte
L B A
LB
D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood* / Q000276:immunology; D001324:Autoantigens / Q000276:immunology*; D002956:Citrulline / Q000276:immunology*; D003937:Diagnosis, Differential; D006801:Humans; D010456:Peptides, Cyclic / Q000276:immunology; D012217:Rheumatoid Factor; D012680:Sensitivity and Specificity; D013583:Synovial Membrane / Q000276:immunology / Q000473:pathology
D001323:Autoantibodies; D001324:Autoantigens; D010456:Peptides, Cyclic; D002956:Citrulline; D012217:Rheumatoid Factor