The diagnostic utility of the anti-CCP antibody test is no better than rheumatoid factor in South Africans with early rheumatoid arthritis (original) (raw)
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Clinical Rheumatology, 2007
To compare the diagnostic powers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) in a population selected for its high statistical relevance, over a 6-month period, an informed consent to test for anti-CCP was obtained from 1,025 consecutive patients for whom RF was ordered at a University laboratory. Within 1 year, a diagnosis was obtained without informing the physician about the anti-CCP result. Extensive statistical analyses were performed. A total of 768 patients satisfied the inclusion criteria, and 132 were classified as having RA, yielding a pre-test probability of RA of 17%. The sensitivities for anti-CCP and RF were 62 and 64% (P= 0.83), and the specificities were 97 and 90% (P<0.001), respectively. The positive predictive value (PPV) was 79% for anti-CCP and 56% for RF (P<0.001), whereas the negative predictive value was 92% for both. The likelihood ratio (LR) was 17.9 for anti-CCP and 6.2 for RF (P< 0.005). Forty RA patients were diagnosed with RA of less than 2 years length, and the same significant statistic differences between anti-CCP and RF were observed. Placing the results of both tests together, or using different cutoff points, increased the diagnostic utility of the tests. The anti-CCP test has statistically shown significant higher specificity, PPV, and LR for RA than the RF test in a clinically diverse population. If new criteria are to be devised to help diagnose early RA, anti-CCP should be included because it has a greater diagnostic impact than RF.
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Rheumatoid arthritis (RA) is autoimmune disease associated with chronic inflammation of joints causing deformities and functional impairment. Diagnosis primarily depends on clinical manifestations because of lack of suitable diagnostic tests. Rheumatoid factor (RF) is an autoantibody specific for Fc portion of human IgG. RF has low specificity as high false positive results are common in general population. Anti CCP antibody is also useful marker to diagnose rheumatoid arthritis and included in one of the criteria of American College of Rheumatology (ACR) /European League against Rheumatism (EULAR) classification of RA. Thus the present study was planned to compare the diagnostic utility of RF and Anti CCP antibody test in Rheumatoid arthritis patients in a Tertiary Care Hospital. Aim & Objective: To compare the diagnostic utility of RF and Anti CCP antibody test in Rheumatoid arthritis patients. Material & Methods: A total of 72 samples were taken from clinically suspected RA patients over a period of 3 months. RF was determined by latex agglutination method (STAR DIAGNOSTICS) and Anti CCP antibody by ELISA (IMTEC ANTI CCP ANTIBODIES ELISA-GERMANY). The tests were performed as per manufacturer's instructions. Results & Discussion: Out of total 72 samples tested, 47(58.33%) were positive. Both RF and Anti CCP Antibody was positive in 9 cases. Only RF positivity was seen in 8 cases and only Anti CCP antibody was positive in 30 cases. In present study combination of Anti CCP antibody and Rheumatoid factor together have shown positive predictive value for Rheumatoid Arthritis patients which lack specific signs and symptoms related to diagnosis of RA Conclusion: Anti CCP antibody test and RF can be used concomitantly to diagnose Rheumatoid arthritis and can be used in clinical settings so that appropriate management can be initiated to decrease future morbidity.
2014
Anti-CCP Rheumatoid arthritis 19 ACPA (anti-citrullinated protein antibody) tests are today systematically added to clinical and radiological inves-20 tigations when diagnosing rheumatoid arthritis (RA), and the inclusion of ACPA positivity in the new 2010 RA 21 criteria underlines their importance. 22 The aim of this study was to determine the sensitivity and specificity of different ACPA assays and IgA, IgG 23 and IgM isotypes of rheumatoid factor (RF) in a cohort of patients with early RA in order to assess the value of 24 combining the tests. The serum samples were obtained from 46 RA patients, 80 patients with systemic rheumatic 25 disease, and 20 blood donors. ACPAs were measured using five different commercial kits. 26 The receiver operating characteristic (ROC) curves of the anti-ACPA tests had area under the curve (AUC) values 27 of 0.60-0.83. The diagnostic accuracy of the Bio-Rad multiplex flow immunoassay, a new technology for ACPA 28 testing, was very similar to that of the other widely used commercial immunoassays. The EliA CCP-Phadia 29 test was the most the most specific, and had the best positive likelihood ratio and positive predictive values, 30 whereas the anti-CCP Inova 3.1 test was the most sensitive, and had the best negative likelihood ratio and 31 negative predictive values. 32 The best combination to use for early RA screening was an ACPA test together with IgM and IgA RF.
2016
The rheumatoid arthritis (RA) is an auto-immune, rheumatic and chronic inflammatory disease, characterized by joints damage. The early diagnosis of RA allows the initiation of a treatment which offers to the patients more chance of remission and avoids the evolution towards the unrecoverable deformity of joints. The objective of this study is to evaluate the performance of recent tests for the determination of anti-CCP antibodies and FR by ELISA in Benin Republic. This analytical, retrospective (2 years 6 months) and prospective (7 months) study allowed us to collect 36 patients meeting the American College of Rheumatology (ACR) criteria for RA and 24 controls. A comparison was made with the latex agglutination test for rheumatoid factors and a search of rheumatoid factors (RF) on the one hand and anti-cyclic citrullinated peptide. In our study, the specificity of anti-CCP assay (100 %) is higher than that of RF-ELISA (91.7%). The sensitivity of RF-ELISA assay is higher (77.8 %) than that of anti-CCP assay (66.7%). The latex test for rheumatoid factors has a sensitivity of 33.3 %. The positive predictive value (PPV) of anti-CCP assay (100 %) is higher than that of RF-ELISA assay (93.33 %). The positive-likelihood ratio (LR+) of anti-CCP assay is higher than the LR+ of RF-ELISA assay (4.96). The negative-likelihood ratio (LR-) of anti-CCP assay (0.33) is higher than the LR-of RF-ELISA assay (0.24). In conclusion, the anti-CCP assay has the highest specificity and RF-ELISA assay shows the highest sensitivity. In conclusion, the association of the two assays enhances a better diagnosis value for RA.
The aim of this study was to evaluate the performance of anti-cyclic citrullinated peptide antibodies (anti-ccp) versus Rheumatoid Factor (RF) in the diagnosis of rheumatoid arthritis in serum sample of patients with clinical manifestation of arthritis using ELISA technique. One hundred and twenty patients with clinical presentation of rheumatoid arthritis and fifty apparently healthy individuals (25 males and 25 females) were enrolled in this study. The mean age of patients group and control was 36.45years versus 34.72 years .Among patients, males represented (8.3%) compared with (91.7%) of females. In control group males represented (52%) versus (48%) females. There was a statistical significant difference (p>0.05) between patients and control group in RF and anti-ccp values. Eighty five percent of patients gave positive results for anti-ccp compared with (100%) negative results in control group. RF was detected in (41.66 %) of patients sera compared with (58.33 %) which gave negative results. RF ELISA gave negative results in (100%) of control group . Only 10(8, 33%) out of 120 patients gave negative results in RF and anti-ccp ELISA, compared with 42(35%) out of 120 gave positive results in both tests. In 60(50%) out of 120 RA patients RF gave negative results and at the same time gave positive results when retested using anti-ccp ELISA .Only 8(6.66%) out of 120 RA patients gave negative result in anti-ccp ELISA technique and RF was detected in positive value. The sensitivity of anti-ccp ELISA was (85%) versus (41.66%) for RF. The Specificity of anticcp ELISA was (55.55%) versus (14.28%) for RF. Positive predictive value for anti-ccp ELISA was 41.17% versus (84%) for RF. Negative predictive value for anti-ccp ELISA was 55.55% versus 14.28 for RF ELISA .False positive value in anti-ccp ELISA was 58.82% versus 16%for RF ELISA. False negative value in anti-ccp ELISA was 44.44% versus 85.71%for RF . This study concludes that anti-ccp ELISA was more sensitive and specific in diagnosis of RA than RF ELISA technique.
Introduction: In the last 70 years, Rheumatoid Factor (RF) was considered the most useful laboratory marker in patients with rheumatoid arthritis (RA). The next very important milestone for the RA diagnosis was the discovery of anti-citrullinated peptide/protein antibodies (ACPA). The detection of ACPA is usually done with the CCP test of the second generation, CCP2. Objective: To evaluate the performances of RF and CCP2 tests and to see whether or not the performance of both tests together is better then the performances of either of the tests alone. Materials and Methods: We performed a cross-sectional study with 380 participants of which 155 RA patients who fulfilled the American College of Rheumatology (ACR) 1987 classification criteria for RA, 120 patients with inflammatory and other connective tissue diseases (Non-RA) and 105 healthy controls (HC), at the Rheumatology Clinic in Skopje, Macedonia. The patients and controls were tested for RF and ACPA. Results: The mean age of the RA patients was 50 years, and 87 % of the patients were female. The average duration of the disease has been 6 years. In this group of patients, CCP2 test showed identical sensitivity of 0,69 and better specificity than RF (0,95 vs. 0,87 respectively). For the patients who tested positive for both tests, the sensitivity was lower 0,60 and for the patients who were either ACPA or RF positive, sensitivity was slightly higher 0,73. The specificity of 0,88 for both or either of the tests was identical with that of RF. The positive likelihood ratio was 13,8 for the CCP2 test, 5,3 for RF and 5,1 for both tests done together. Ninety four out of 155 RA patients were positive for both ACPA and RF, 20 patients were positive for either one of the antibodies of which 7 (4,5%) RA patients were only anti-CCP positive and 13 (8,3%) patients were only RF positive. Conclusion: The results from our study showed that the sensitivity and specificity of both tests, done in parallel, does not differ much from the sensitivity of either of the tests alone and from the specificity of RF, respectfully. Still, CCP2 test showed the highest specificity and positive likelihood ratio as was expected. The results from our study support the idea that in countries like Macedonia, which can not afford enough CCP2 antibody kits, we may use RF first, especially in patients who are not likely to meet any clinical criteria for RA. In patients with early undifferentiated arthritis or early RA we may use both antibodies in order to select the patients who will need more aggressive treatment.
The Journal of rheumatology, 2006
To compare the diagnostic value of anti-cyclic citrullinated peptide (anti-CCP) and anti-Sa antibodies in serum for prediction of rheumatoid arthritis (RA) in an outpatient clinic for connective tissue diseases and spondyloarthritides. Methods. A cross-sectional study was carried out to analyze the presence or absence of anti-CCP and anti-Sa antibodies in the sera of 250 randomly selected patients. The disease distribution in the study was as follows: 87 patients had RA (34.8%); 90 (36%) had other connective tissue diseases (CTD); 50 (20%) spondyloarthritis; 19 (7.6%) polymyalgia rheumatica; and 4 (1.6%) juvenile idiopathic arthritis. Results. Anti-CCP antibodies were detected in 63 patients with RA and in 9 patients with other illnesses [sensitivity 72.4%, specificity 94.4%, positive predictive value (PPV) 87.5%]. Anti-Sa antibodies were detected in 38 patients with RA and in 6 patients with other illnesses (sensitivity 43.6%, specificity 96.3%, PPV 86.3%). Anti-CCP and anti-Sa results were discordant in up to 47 of 87 RA patients. No relation between the presence of anti-Sa and higher or lower titers of anti-CCP antibodies was observed. Conclusion. The diagnostic value in RA is similar for both antibodies. However, the sensitivity of anti-CCP detection is higher than that of anti-Sa. Our results suggest that presence of anti-Sa antibodies in serum may be useful as a complementary assay when anti-CCP antibodies are negative and RA is suspected.
IP innovative publication pvt. ltd, 2019
Introduction: Rheumatoid factor (RF) has been routinely used as a diagnostic test for rheumatoid arthritis (RA). RA should be diagnosed early to prevent joint injury before the damages become inevitable. Several new laboratory tests have also been used, the commonest of them being detection of antibodies to cyclic citrullinated peptides (anti-CCP or ACPA). For the diagnosis of individuals with rheumatoid arthritis and also for prognosis these two tests are universally performed. Antibodies produced against cyclic citrullinated peptide (ACPA) have a higher specificity with almost equal sensitivity when compared to Rheumatoid Factor. Hence we proceeded to analyse these two parameters’ in our Immunology laboratory. Aim: To analyse presence of Rheumatoid factor and ACPA in individuals with Rheumatalogical disorders. Materials and Methods: RF was tested qualitatively by using latex agglutination. Anti-CCP was tested using mono specific ELISA kit. Our study is a retrospective observational one, performed on analysis of the reports of the samples received and tested in the Immunology laboratory of a tertiary care hospital. 331 samples referred for testing both RF and ACPA during October 2018 to December 2018 were considered to analyse the correlation. Results: Out of 331 samples tested “18.1% of them were both RF and Anti-CCP positive, 9.3% were only Anti-CCP positive and RF negative, 5.4% were only RF positive and Anti-CCP negative and 67% were negative for both”. Conclusion: Anti-CCP is better than RF in terms of veracity of the diagnosis, and when both these are combined the diagnostic accuracy of RA is increased.