How are anti–cyclic citrullinated peptide (anti-CCP) antibody testing results interpreted?

Updated: Jan 16, 2020
  • Author: Duane Kirksey, MD, MSc; Chief Editor: Eric B Staros, MD  more...
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Answer

Answer

Anti–cyclic citrullinated peptide (anti-CCP) antibody levels are characteristically elevated in rheumatoid arthritis, although they can be elevated in other rheumatologic conditions associated with inflammatory arthritis, such as systemic lupus erythematosus. [3, 4, 5, 6, 7] Anti–citrullinated protein antibody (ACPA) level was added to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) diagnostic criteria for rheumatoid arthritis. These criteria, including ACPA levels, identify more patients with rheumatoid arthritis than the previous 1987 criteria. [8] ACPA can be present in the early presentation of rheumatoid arthritis while the rheumatoid factor (RF) is negative. Therefore, if ACPA is identified, the patient likely has rheumatoid arthritis.

The antigen used in most assays is filaggrin, although other antigens are available. [9] ACCP antibodies are a subset of ACPA and are not completely cross-reactive with other citrullinated proteins. [10] The most common test for anti-CCP2 has a sensitivity of 61.6-75.2% for rheumatoid arthritis and specificity of 94-99%. [11] Although multiple assays are available, including antimutated citrullinated vimentin antibody and several generations of anti-CCP, they have all been shown to have comparable diagnostic performance. [1]


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