title: Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody for juvenile idiopathic arthritis.
abstract: OBJECTIVE
  To estimate the diagnostic accuracy of the anti-CCP test in JIA and to evaluate factors associated with higher accuracy.
  
  
  METHODS
  Two investigators performed an extensive search of the literature published between January 2000 and January 2014. The included articles were assessed by the Quality Assessment of Diagnostic Accuracy Studies tool. The meta-analysis was performed using a summary ROC (SROC) curve and a bivariate random-effect model to estimate sensitivity and specificity across studies.
  
  
  RESULTS
  The bivariate meta-analysis yielded a pooled sensitivity and specificity of 10% (95% confidence interval (CI): 6.0%-15.0%) and 99.0% (95% CI: 98.0%-100.0%). The area under the SROC curve was 0.96. Sensitivity estimates were highly heterogeneous, which was partially explained by the higher sensitivity in the rheumatoid factor-positive polyarthritis (RF+ PA) subtype (48.0%; 95% CI: 31.0%-65.0%) than in the other subtypes (17.0%; 95% CI: 14.0%-20.0%) and the higher sensitivity of the Inova assay (17.0%; 95% CI: 14.0%-20.%%) than the other assays (0.05%; 95% CI: 2.0%-11.0%).
  
  
  CONCLUSIONS
  Anti-CCP antibody test has a high specificity for the diagnosis of JIA. The sensitivity of this test is low and varies across populations but is higher in RF+ PA than in other JIA subtypes.
authors: Department of Laboratory Medicine, General Hospital of Jinan Military Area, Jinan, Shandong 250031, China.
authors: Yan
authors: Y
authors: Wang
authors: Department of Laboratory Medicine, Jinan Central Hospital, Jinan, Shandong 250013, China.
authors: Fengyan
authors: F
authors: Pei
authors: Department of Laboratory Medicine, General Hospital of Jinan Military Area, Jinan, Shandong 250031, China.
authors: Xingjuan
authors: X
authors: Wang
authors: Department of Laboratory Medicine, General Hospital of Jinan Military Area, Jinan, Shandong 250031, China.
authors: Zhiyu
authors: Z
authors: Sun
authors: Department of Laboratory Medicine, General Hospital of Jinan Military Area, Jinan, Shandong 250031, China.
authors: Chengjin
authors: C
authors: Hu
authors: Division of Chest Disease, The Fourth Hospital of Jinan, Jinan, Shandong 250031, China.
authors: Hengli
authors: H
authors: Dou
mesh_terms: D001171:Arthritis, Juvenile / Q000097:blood / Q000175:diagnosis* / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D006801:Humans; D010456:Peptides, Cyclic / Q000276:immunology*; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide