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

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Abstract

To establish the diagnostic utility of the anti-cyclic-citrullinated peptide antibody (aCCP) test in Black South Africans with early rheumatoid arthritis (RA). A cross-sectional study comparing the rheumatoid factor (RF) and aCCP status in RA patients and a control group consisting of healthy subjects, and patients with systemic lupus erythematosus (SLE) and scleroderma. The sensitivity, specificity, positive (PPV) and negative predictive values of the aCCP test alone were 82.5%, 84.9%, 87.6% and 79% versus 81.7%, 90.7%, 92.5% and 78% for RF alone. The best specificity (95.3) and PPV (95.8%) was observed when both aCCP and RF tests were positive. Patients with erosive disease had a significantly higher mean RF titre compared with those with non-erosive disease (p = 0.007). There was a trend towards an association of smoking (OR = 4.1, 95% CI = 0.9–18.6) and functional disability (p = 0.07) with RF-positive status. No similar clinical associations were observed with aCCP. Almost a third of SLE patients were aCCP positive. Despite the best specificity and PPV observed when both the aCCP and RF tests were positive, our findings suggest that testing for aCCP is only cost-effective in the RF-negative patient in whom there is a strong clinical suspicion of RA.

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References

  1. Landewe RB (2003) The benefits of early treatment in rheumatoid arthritis: confounding by indication, and the issue of timing. Arthritis Rheum 48:1–5

    Article  PubMed  Google Scholar 

  2. Arnett F, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification. Arthritis Rheum 31:315–324

    Article  CAS  PubMed  Google Scholar 

  3. Niewold TB, Harrison MJ, Paget SA (2007) Anti-CCP antibody testing as a diagnostic and prognostic tool in rheumatoid arthritis. QJM 100:193–201

    Article  CAS  PubMed  Google Scholar 

  4. Kastbom A, Strandberg G, Lindroos A, Skogh T (2004) Anti-CCP antibody test predicts the disease course during 3 years in early rheumatoid arthritis (the Swedish TIRA project). Ann Rheum Dis 63:1085–1089

    Article  CAS  PubMed  Google Scholar 

  5. Machold KP, Stamm TA, Nell VP, Pflugbeil S, Aletaha D, Steiner G et al (2007) Very recent onset rheumatoid arthritis: clinical and serological patient characteristics associated with radiographic progression over the first years of disease. Rheumatology (Oxford) 46:342–349

    Article  CAS  Google Scholar 

  6. Nishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakazawa T, Kawano S et al (2007) Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 146:797–808

    PubMed  Google Scholar 

  7. Abdel-Nasser AM, Mahmoud MH, El Mansoury TM, Osman AM (2008) Anti-CCP2 is an adjunct to, not a surrogate for, rheumatoid factor in the diagnosis of rheumatoid arthritis: diagnostic utility of anti-CCP2 antibodies in Egyptian patients with rheumatoid arthritis. Scand J Rheumatol 37:329–336

    Article  CAS  PubMed  Google Scholar 

  8. Aflaky E, Shenavandeh S, Ashraf MJ (2009) A comparison of performance of anti-cyclic citrullinated peptide 2 and citrullinated protein antibodies in the diagnosis of rheumatoid arthritis in Iranian patients. Rheumatol Int (in press)

  9. Vanichapuntu M, Phuekfon P, Suwannalai P, Verasertniyom O, Nantiruj K, Janwityanujit S (2009) Are anti-citrulline autoantibodies better serum markers for rheumatoid arthritis than rheumatoid factor in Thai population? Rheumatol Int (in press)

  10. Gupta R, Thabah MM, Aneja R, Kumar A, Varghese T, Chandrasenan PJ (2009) Usefulness of anti-CCP antibodies in rheumatic diseases in Indian patients. Indian J Med Sci 63:92–100

    Article  PubMed  Google Scholar 

  11. van der Heijde DM, van’t Hof MA, van Riel PL, van de Putte L (1992) Disease activity score. Ann Rheum Dis 51:140

    PubMed  Google Scholar 

  12. Kirwan JR, Reeback JS (1986) Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol 25:206–209

    Article  CAS  PubMed  Google Scholar 

  13. Elkayam O, Segal R, Lidgi M, Caspi D (2006) Positive anti-cyclic citrullinated proteins and rheumatoid factor during active lung tuberculosis. Ann Rheum Dis 65:1110–1112

    Article  CAS  PubMed  Google Scholar 

  14. Kakumanu P, Yamagata H, Sobel ES, Reeves WH, Chan EK, Satoh M (2008) Patients with pulmonary tuberculosis are frequently positive for anti-cyclic citrullinated peptide antibodies, but their sera also react with unmodified arginine-containing peptide. Arthritis Rheum 58:1576–1581

    Article  CAS  PubMed  Google Scholar 

  15. Hodkinson B, Musenge E, Tikly M (2009) Osteoarticular tuberculosis in patients with systemic lupus erythematosus. QJM 102:321–328

    Article  CAS  PubMed  Google Scholar 

  16. Avouac J, Gossec L, Dougados M (2006) Diagnostic and predictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis 65:845–851

    Article  CAS  PubMed  Google Scholar 

  17. Nell VP, Machold KP, Stamm TA, Eberl G, Heinzl H, Uffmann M et al (2005) Autoantibody profiling as early diagnostic and prognostic tool for rheumatoid arthritis. Ann Rheum Dis 64:1731–1736

    Article  CAS  PubMed  Google Scholar 

  18. Schellekens GA, Visser H, de Jong BA, van den Hoogen FH, Hazes JM, Breedveld FC et al (2000) The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Arthritis Rheum 43:155–163

    Article  CAS  PubMed  Google Scholar 

  19. Qing YF, Zhang QB, Zhou JG, Yuan GH, Wei J, Xing Y et al (2009) The detecting and clinical value of anti-cyclic citrullinated peptide antibodies in patients with systemic lupus erythematosus. Lupus 18:713–717

    Article  CAS  PubMed  Google Scholar 

  20. Mikuls TR, Holers VM, Parrish L, Kuhn KA, Conn DL, Gilkeson G et al (2006) Anti-cyclic citrullinated peptide antibody and rheumatoid factor isotypes in African Americans with early rheumatoid arthritis. Arthritis Rheum 54:3057–3059

    Article  PubMed  Google Scholar 

  21. Gould T, Tikly M, Asherson R, Loizou S, Singh S (2006) Prevalence and clinical correlates of anti-phospholipid antibodies in South Africans with systemic lupus erythematosus. Scand J Rheumatol 35:29–34

    Article  CAS  PubMed  Google Scholar 

  22. Ingegnoli F, Galbiati V, Zeni S, Meani L, Zahalkova L, Lubatti C et al (2007) Use of antibodies recognizing cyclic citrullinated peptide in the differential diagnosis of joint involvement in systemic sclerosis. Clin Rheumatol 26:510–514

    Article  PubMed  Google Scholar 

  23. Santiago M, Baron M, Miyachi K, Fritzler MJ, Abu-Hakima M, Leclercq S et al (2008) A comparison of the frequency of antibodies to cyclic citrullinated peptides using a third generation anti-CCP assay (CCP3) in systemic sclerosis, primary biliary cirrhosis and rheumatoid arthritis. Clin Rheumatol 27:77–83

    Article  PubMed  Google Scholar 

  24. Tikly M, Zannettou N, Hopley M (2003) A longitudinal study of rheumatoid arthritis in South Africans. MedGenMed 5:2

    PubMed  Google Scholar 

  25. Benitha R, Tikly M (2007) Functional disability and health-related quality of life in South Africans with rheumatoid arthritis and systemic lupus erythematosus. Clin Rheumatol 26:24–29

    Article  PubMed  Google Scholar 

  26. Klareskog L, Stolt P, Lundberg K, Kallberg H, Bengtsson C, Grunewald J et al (2006) A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 54:38–46

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Rheumatology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, P.O. Bertsham, Johannesburg, South Africa

    Bridget Hodkinson & Mohammed Tikly

  2. Department of Immunology, Medical Research Council Unit for Inflammation and Immunity, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa

    Pieter W. A. Meyer & Ronald Anderson

  3. Epidemiology Centre, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

    Eustasius Musenge

  4. Department Internal Medicine, Steve Biko Pretoria Academic Hospital and University of Pretoria, Pretoria, South Africa

    Mahmood M. T. Ally

  5. Division of Immunology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa

    Ahmed A. Wadee

Authors
  1. Bridget Hodkinson
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  2. Pieter W. A. Meyer
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  3. Eustasius Musenge
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  4. Mahmood M. T. Ally
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  5. Ahmed A. Wadee
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  6. Ronald Anderson
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  7. Mohammed Tikly
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Correspondence to Mohammed Tikly.

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Hodkinson, B., Meyer, P.W.A., Musenge, E. et al. The diagnostic utility of the anti-CCP antibody test is no better than rheumatoid factor in South Africans with early rheumatoid arthritis. Clin Rheumatol 29, 615–618 (2010). https://doi.org/10.1007/s10067-010-1374-x

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  • DOI: https://doi.org/10.1007/s10067-010-1374-x

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