Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis.
BACKGROUND
Rheumatoid factor (RF) and autoantibodies against cyclic citrullinated peptide (CCP) are markers that might help physicians diagnose rheumatoid arthritis.


OBJECTIVE
To determine whether anti-CCP antibody more accurately identifies patients with rheumatoid arthritis and better predicts radiographic progression than does RF.


METHODS
MEDLINE through September 2006 and reference lists of retrieved studies and review articles.


METHODS
Studies in any language that enrolled at least 10 participants and that examined the role of anti-CCP antibody and RF in the diagnosis or prognosis of known or suspected rheumatoid arthritis.


METHODS
Two authors independently evaluated studies for inclusion, rated methodological quality, and abstracted relevant data.


RESULTS
The DerSimonian-Laird random-effects method was used to summarize sensitivities, specificities, and positive and negative likelihood ratios from 37 studies of anti-CCP antibody and 50 studies of RF. The pooled sensitivity, specificity, and positive and negative likelihood ratios for anti-CCP antibody were 67% (95% CI, 62% to 72%), 95% (CI, 94% to 97%), 12.46 (CI, 9.72 to 15.98), and 0.36 (CI, 0.31 to 0.42), respectively. For IgM RF, the values were 69% (CI, 65% to 73%), 85% (CI, 82% to 88%), 4.86 (CI, 3.95 to 5.97), and 0.38 (CI, 0.33 to 0.44). Likelihood ratios among IgM RF, IgG RF, and IgA RF seemed to be similar. Results from studies of patients with early rheumatoid arthritis were similar to those from all studies. Three of 4 studies found that risk for radiographic progression was greater with anti-CCP antibody positivity than with IgM RF positivity.


CONCLUSIONS
Many studies had methodological limitations. Studies of RF were heterogeneous and had wide ranges of sensitivity and specificity.


CONCLUSIONS
Anti-CCP antibodies are more specific than RF for diagnosing rheumatoid arthritis and may better predict erosivedisease.
Nishimura
Kunihiro
K
Department of Health Policy Management, Harvard School of Public Health, Boston, Massachusetts 02215, USA. knishimu@hsph.harvard.edu
Sugiyama
Daisuke
D
Kogata
Yoshinori
Y
Tsuji
Goh
G
Nakazawa
Takashi
T
Kawano
Seiji
S
Saigo
Katsuyasu
K
Morinobu
Akio
A
Koshiba
Masahiro
M
Kuntz
Karen M
KM
Kamae
Isao
I
Kumagai
Shunichi
S
D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D007070:Immunoglobulin A / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D016013:Likelihood Functions; D010456:Peptides, Cyclic / Q000276:immunology*; D011379:Prognosis; D012217:Rheumatoid Factor / Q000097:blood*; D012680:Sensitivity and Specificity
D001323:Autoantibodies; D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor