A comparison of performance of anti-cyclic citrullinated peptide 2 and citrullinated protein antibodies in the diagnosis of rheumatoid arthritis in Iranian patients

Abstract

Antibodies to citrullinated proteins and rheumatoid factor (RF) are widely used in patients with rheumatoid arthritis (RA) and the antibodies to citrullinated proteins appear to be the most specific markers of the disease. The objective was to compare the diagnostic performance of the anti-cyclic citrullinated peptide 2 (anti-CCP2) and citrullinated protein Antibodies (CPA) with RF in the diagnosis of RA. Serum samples of 139 patients with RA and 131 patients with other rheumatic diseases were checked for anti-CCP2, CPA uses citrullinated recombinant rat filaggrin as the antigen assay, and RF. The specificity, sensitivity, and receiver operating characteristic (ROC) of tests were then compared. The sensitivity of anti-CCP2, CPA, and RF were 82.7, 83.5, and 61.5%, respectively. The specificities of the tests were 91.2, 78.6, and 90.5%, respectively. The area under ROC curves for the tests were 0.925, 0.890, and 0.847, respectively. Exclusion of overlaps was associated with improved specificity for CPA but no change in the specificity of RF and anti-CCP. The sensitivity of anti-CCP2, CPA, and RF were 66.7, 77.8, and 51.9% for patients with early RA, respectively. The findings of the present study indicate that anti-CCP2 might be of a better diagnostic value for the diagnosis of RA. They also showed that CPA and in the second place anti-CCP2 were useful in the diagnosis of early RA.

A Comparative Assessment of the Diagnostic Value of Anti-cyclic Citrullinated Peptide Antibodies and Rheumatoid Factor in Rheumatoid Arthritis

“…In our study the sensitivity and specificity of RF were 46.2 and 90.29%, respectively. These values are similar to those reported by Aflaki using latex fixation test [9] but are different from Hodkinson's study [15]. A literature review shows that the sensitivity of RF in RA has ranged from 26 to 90 percent [16].…”

“…For example, Moghimi et al [8] showed that the overall performance of the anti-CCP and RF tests for differentiating RA and other inflammatory polyarthritis were similar [8]. Meanwhile in another research Aflaky et al [9] revealed that AUC (Area under the Curve) for anti-CCP was higher than that for RF and concluded that anti-CCP might be of a better diagnostic value than RF test [9]. On the other hand, Abolghasemi et al [10] offers a combination of these tests rather than anti-CCP or RF to get the best results in RA diagnosis and prognosis [10].…”

The diagnostic utility of the anti-CCP antibody test is no better than rheumatoid factor in South Africans with early rheumatoid arthritis

“…Most studies on the diagnostic utility of the aCCP test in RA have been done in industrialized countries on subjects of European ancestry [6], with only a few done in the developing world [7][8][9][10]. In the absence of any published studies on the prevalence and specificity of aCCP in RA in sub-Saharan Africa, we undertook a cross-sectional case-control study to establish the diagnostic utility of the RF and aCCP tests in urbanized Black South Africans with early RA.…”

Combination of Serological Tests (Anti-CCP Antibody, Rheumatoid Factor IgM ELISA and Latex Test) are more Useful in Detection of Rheumatoid Arthritis

“…In another study conducted by Saraux et al (2003) sensitivity of RF Latex test was 45%. In a different study Aflaky et al (2010) reported similar values of RF Latex test. Nishimura et al (2007) reported that sensitivity of RF is 69% and specificity is 85%.…”