Second generation anti-citrullinated peptide antibodies to diagnose rheumatoid athritis

January 01, 0001

Second generation anti-citrullinated peptide antibodies to diagnose rheumatoid athritis

These UK investigators compared the accuracy of Anti-citrullinated peptide antibodies (ACPA) and rheumatoid factor in diagnosing rheumatoid arthritis in patients with early symptoms of the disease in a systematic review. They included studies that reported 2 × 2 data on ACPA for the diagnosis of rheumatoid arthritis.

They found: "151 studies were included, with considerable heterogeneity in sensitivity (range, 12% to 93%) and specificity (range, 63% to 100%). In cohort studies that investigated second-generation anti-cyclic citrullinated peptide antibodies (anti-CCP2) in patients with early rheumatoid arthritis (less than 2 years), summary sensitivity and specificity were 57% and 96%, respectively. Case-control and cross-sectional studies and studies of patients with established rheumatoid arthritis all overestimated sensitivity. Anti-CCP2 had greater specificity than rheumatoid factor (96% vs. 86%), with similar sensitivity. Evidence was insufficient to ascertain whether the combination of anti-CCP2 and rheumatoid factor provides additional benefit over anti-CCP2 alone."

The authors concluded: "Anti-CCP2 should be included in the work- up of patients with early symptoms of rheumatoid arthritis."

Use of CCP-2 sounds like a good step forward in the assessment of patients with possible rheumatoid arthritis.

For the full abstract, click here.

Ann Intern Med 152(7):456-464, 6 April 2010
© 2010 to the American College of Physicians
Systematic Review: Accuracy of Anti-Citrullinated Peptide Antibodies for Diagnosing Rheumatoid Arthritis. Penny F. Whiting, Nynke Smidt, Jonathan A.C. Sterne, et al. Correspondence to Dr. Whiting: [email protected]

Category: M. Musculoskeletal. Keywords: rheumatoid arthritis, diagnosis, anti-citrullinated peptide antibodies, rheumatoid factor, systematic review, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 20 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.