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Predictive value of antibodies to cyclic citrullinated peptide in patients with early arthritis

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Abstract

The objective of this study was to determine the diagnostic value for rheumatoid arthritis (RA) of antibodies to cyclic citrullinated peptides (anti-CCP) in patients with early arthritis and vasculitis. Sixty-four adult patients with early arthritis and disease duration of less than 4 months were clinically diagnosed by an experienced rheumatologist as having RA (n=27), spondyloarthropathy (n=11), and undifferentiated arthritis (n=26). Eighteen patients with vasculitis were also included in the study. The patients with early arthritis were followed up for 9 months. After the follow-up period, five of 26 patients with undifferentiated arthritis were diagnosed as having RA. All serum samples were tested for anti-CCP and IgM rheumatoid factor (IgM-RF). The anti-CCP positivity in RA patients (44.4%) was significantly more frequent than in patients with undifferentiated arthritis (3.8%), spondyloarthropathy (0%), and vasculitis (5.6%) (p=0.001, p<0.01, and p<0.01, respectively). The frequency of IgM-RF positivity was 40.7% in RA, 7.7% in undifferentiated arthritis, 0% in spondyloarthropathy, and 22.2% in vasculitis groups. The respective specificity of anti-CCP and IgM-RF tests for early RA were 97.3 and 94.6%, and the respective sensitivity of them were 44.4 and 40.7%, respectively. The combination of anti-CCP and IgM-RF positivity had a very high specificity and positive predictive value (100%) but a rather low sensitivity (33.3%). When either anti-CCP or IgM-RF positivity combined into one criterion, the sensitivity became high (51.9%) but the specificity decreased to 91.9%. Overall performance of anti-CCP test alone for the early RA was higher than IgM-RF and the combination of anti-CCP and IgM-RF (p<0.05), and was similar to the combination of anti-CCP or IgM-RF. The specificity of positive anti-CCP test for diagnosis of established RA reached up to 100%. In conclusion, the anti-CCP test is a new diagnostic test with extremely high specificity for RA. Anti-CCP antibody testing combined with IgM-RF testing has additional value over IgM-RF testing alone in patients with early arthritis.

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  1. Aşkın Ateş

    Present address: Refik Belendir sokak, 57/5, Y. Ayrancı, 06550, Ankara, Turkey

Authors and Affiliations

  1. Department of Rheumatology, Numune Training and Research Hospital, Ankara, Turkey

    Aşkın Ateş & Yaşar Karaaslan

  2. Department of Microbiology, Numune Training and Research Hospital, Ankara, Turkey

    Sebahat Aksaray

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  1. Aşkın Ateş
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  2. Yaşar Karaaslan
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Correspondence to Aşkın Ateş.

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Ateş, A., Karaaslan, Y. & Aksaray, S. Predictive value of antibodies to cyclic citrullinated peptide in patients with early arthritis. Clin Rheumatol 26, 499–504 (2007). https://doi.org/10.1007/s10067-006-0309-z

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  • DOI: https://doi.org/10.1007/s10067-006-0309-z

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