The prevalence and diagnostic performance of anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: the predictive and discriminative ability of serum antibody level in recognizing rheumatoid arthritis.
OBJECTIVE
The utility of anticyclic citrullinated peptide (anti-CCP) antibody in the diagnosis of rheumatoid arthritis (RA) varies across different studies. We determined the diagnostic performance and predictive ability of anti-CCP for RA.


METHODS
We studied 201 patients with RA and compared them with 208 non-RA patients as controls. RA patients included in the study fulfilled the American College of Rheumatology revised criteria and patients with other diseases as well as those with undifferentiated arthritis (UIA) were used as controls. Anti-CCP was measured by enzyme-linked immunosorbent assay (ELISA) and rheumatoid factor (RF) by the agglutination method. The optimal cutoff value and diagnostic accuracy were determined using receiver operating characteristics (ROC) curve and area under the curve (AUC).The sensitivity and specificity were determined by comparison of RA patients with non-RA controls.


RESULTS
The anti-CCP test was positive in 164 patients with RA for a sensitivity of 81.6%, specificity of 87.5%, and overall accuracy of 84.6%. The respective values for RF were 75.6%, 86.5% and 84.4%. The anti-CCP test discriminated RA from non-RA patients with high accuracy (AUC=0.889 [0.017] 95% CI, 0.856-0.952, P=.001), and predicted progression of UIA to RA with moderate accuracy (AUC=0.733 [0.069], 95% CI 0.60-0.87, P<.006) at a sensitivity of 75% and a specificity of 68.1%. Among 60 UIA patients, in 16 (26.7%) who differentiated to RA, the mean (standard deviation) for anti-CPP was significantly higher than in 24 (40%) patients who progressed to non-RA (134.8 [172] vs 46 [86] U/mL, P<.01).


CONCLUSIONS
These findings indicate that anti-CCP yields higher sensitivity and overall accuracy, but slightly greater specificity than RF for diagnosis of RA. Anti-CCP positivity, particularly a higher level of serum antibody in patients with UIA, may be a predictor of subsequent RA.
Heidari
Behzad
B
Department of Medicine, Babol University of Medical Sciences, Babol, Mazandran, Iran. heidaribeh@yahoo.com
Firouzjahi
Alireza
A
Heidari
Parnaz
P
Hajian
Karim
K
D000328:Adult; D000368:Aged; D000372:Agglutination Tests; D019540:Area Under Curve; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood*; D016022:Case-Control Studies; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000097:blood / Q000276:immunology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012217:Rheumatoid Factor / Q000097:blood; D012680:Sensitivity and Specificity
D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor