Abstract
Rheumatoid Arthritis (RA) is the most common systemic inflammatory, auto immune Rheumatic disease. Although the precise aetiology of RA remains unknown1, there is strong evidence for autoimmunity, 6 The aim of the present study is to evaluate the use and significance of Anti CCP antibodies in Rheumatoid Arthritis with RF positive & in RF Sero Negative Rheumatoid Arthritis(early synovitis) and the Healthy Blood Donors as control. In this study a total number of 150 patients (each group50) including both males and females were studied. Anti-CCP was positive in 39 of 50 RA patients (78%), 14 of 50 (28%) Early Synovitis cases & no HBD were positive for Anti CCP. RF was positive in38 of 50 RA patients, 21 of 50 ES patients & 4 of 50 healthy blood donors. Sensitivity of RF Test in RA is 76% & Specificity is 92%. Sensitivity of Anti CCP test in RA is 78% & Specificity is 100%. Anti CCP Test in Sero Negative RA patients (6 out of 12) is 50%. Being a specific marker in advanced RA, the Anti CCP antibody in ES is a very important predictor. So Anti CCP has the hallmark of establishing as a diagnostic tool, early predictor and provides additive sensitivity to RF. The presence of both in serum is a strong indicator of RA. So it should also be included among the diagnostic criteria of RA along with RF. and as a prognostic indicator in RA patients on treatment.
Key Words: Anti CCP, RA, Early Synovitis.
References
- Gerard A. Schellekens, Ben A.W. de Jong, Frank H.J. van den Hoogen et al.Citrulline is an Essential Constituent of Antigenic Determinants Rheumatoid Arthritis–specific Autoantibodies. January 1998; Volume 101 (Number 1):273 –281.
- Thomas Skogh.Does a positive anti-CCP test identify a distinct arthritis entity?Arthritis Research &Therapy, December 2005; Vol 7 (No 6) : 121.
- Kunihiro Nishimura, MD,MPH; MS; Daisuke Sugiyama, MD,MPH;Yoshinori Kogata et al.Annals of Internal Medicine Meta-analysis: Diagnostic Accuracy of Anti–Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor for Rheumatoid Arthritis. American College of Physicians, 2007; 146: 797-808.
- Eric-jan j. A.Kroot,ben a.W.De jong et al.The prognostic value of Anti– cyclic citrullinated peptide antibody in patients with recent – onset Rheumatoid arthritis & Rheumatism. August 2000; vol. 43 no. 8: pp 1831–1835.
- bel altun,Reyhan calipkan,y.Al.oner et al.a new marker in Rheumatoid Arthritis- autoimmunity relation: anti-cyclic citrullinated peptide antibody. Turk j immunol; 2004; 9: 21-265.
- Pooja khosla,s Shankar,lalit duggal et al. Anti ccp antibodies in rheumatoid Arthritis. Rheumatol assoc.2004; 12 : 143 - 46.
- Martinus AM van Boekel, R Vossenaar, Frank HJ van den Hoogen et al. autoantibody systems in rheumatoid arthritis: Specificity, sensitivity and diagn-ostic value Res, 2002; 4:87-93.
- Gerard a.Schellekens,hendrik visser,ben a.W.De jong et al.The diagnostic properties of rheumatoid arthritis antibo-dies recognizing a cyclic citrullinated Arthritis & Rheumatism,2000; vol. 43,no.1: pp 155–156.
- By Anil Vasishta, Diagnosing early-onset rheumatoid Arthritis: The role of anti-CCP antibodies, American clinical Aug-Sep - 2002;
- RDLCyclic Citrullinated Peptide,CCP: A New Serum Markers for Rheumatoid Arthritis, Updated September 4; 2007.
- Nehir samanci, md. sebahat ozdem, md; Halide akbas, et al. Diagnostic value and clinical significance of anti-ccp in patients with Advanced rheumatoid arthritis. journal national medical association, August, 2005;(vol.97) no. 8:
- vanAken,J.H.M.vanBilsen,C.F.Allaart, T.W.J.Huizinga, F.C.Breedveldet al.The Leiden Early Arthritis Clinic,Clin Exp Rheumatol 2003; 21 (Sup31): S100-S105.
- FA van Gaalen,SP Linn-Rasker,WJ van Venrooij et al. Autoantibodies predict progression to Rheumatoid arthritis in undifferentiated arthritis. The Netherlands Arthritis Res Ther, 2003; 5( suppl1):28.
- L.E.Ribeiro H.L.A. Pereira,N.P. Silva,et al. Anti-cyclic citrullinated peptide antibodies and rheumatoid factor in leprosy patients with articular involve-ment. Braz J Med Biol 2008; Res 41.
- The American Association for Clinical Papers in Press doi: 10.2004; 1373/ clinche
- J.W.Zendman,W.J.vanVenrooij and G.J.M. Pruijn et al,Use and significance of anti-CCP autoantibodies in rheumatoid arthritis. Rheumatology; 2006, 45:20–25.
- Ger J.M. Pruijn,Erik R.Vossenaar,Jan WDrijfhout, Walther J. van Venrooij etal. Anti-CCP Antibody Detection Facilitates Early Diagnosis and Prognosis of Rheum-atoid Arthritis. Current Rheumatology Reviews,2005;1, 1-7 1.
- Very early‘Rheumatoid’arthritis cohorts: limited by selection, Oxford University Press on behalf of the British Society for Rheumatology;
- P.Machold1,V.P.K. Nell1,T.A.Stamm et al, The Austrian Early Arthritis Registry. Clin Exp Rheumatol; 2003, 21 (Suppl. 31): S113 - S117.
- Anti - citrullinated protein antibody, Wikipedia.
- CT Chou1HT Liao2,CH Chen et al,The Clinical Application of Anti- CCP in Rheumatoid Arthritis and Other Rheumatic Diseases Biomarker Insights: 2007; 2 :165 – 171.
- Shadick,MD,MPH;NancyR.Cook,ScD;ElizabethW.Karlson,MD et al,C - reactive Protein in the Prediction of Rheumatoid Arthritis in Women. Arch Intern Med. 2006; 166 : 2490-2494.
- The Predictive Power of Anti-Cyclic Citrullinated Peptide Antibodies: Window into Understanding Gene / Environment / Immunity Interactions, 2006, The Journal of Rheumatology; 33:7.
- Ulrich sauerland, heidemarie Becker, matthias seidel et al. Clinical utility of the anti-CCP assay experiences with 700 patients N.Y. acad. Sci. 2005; 1050: 314–318.
- Münevver serdarofluhaoim çakârbay orhan defer et al, the association of anti-ccp antibodies with disease activity in rheumatoid Rheumatol int, 2008 ; 28: 965–970.
Corresponding Author
Dr D.Ayisha M.D
Senior Assistant Professor, Department of Microbiology,
Thanjavur Medical College, Thanjavur Tamilnadu