Dollah, Rusni
(2010)
Anti-cyclic citrullinated peptide
(Anti-CCP) autoantibody as a useful
diagnostic test for the diagnosis of
rheumatoid arthritis.
Masters thesis, Universiti Sains Malaysia.
Abstract
Rheumatoid factors are currently used in the diagnosis of rheumatoid
arthritis and constitute one of the classification criteria proposed by the American
College of Rheumatology. However, rheumatoid factor positivity shows low diagnostic
specificity because it is also present in patients with other autoimmune and infectious
disease and even in a proportion of normal healthy individuals. Recently, another test of
interest in the diagnosis of rheumatoid arthritis is the assay for anti-cyclic citrullinated
peptide (anti-CCP) antibodies. To determine the sensitivity and specificity of anti-cyclic citrullinated
peptide antibodies in rheumatoid arthritis patients attending HUSM using American
College of rheumatology (ACR) criteria as a gold standard and to compare the
sensitivity and specificity of anti-CCP and rheumatoid factor. This was a cross sectional study which conducted from January 2008 to
December 2008. The study consisted of 261 patients, 96 patients with rheumatoid
arthritis (cases) and 165 patients with arthritis or arthralgia but not fulfilled ACR criteria
for rheumatoid arthritis (controls). Serum from each subject was tested for anti-CCP
antibodies and IgG RF by enzyme linked immunosorbent assay (ELISA). However,
antibodies testing unable to do to 12 blood sample from the control group due to blood
lysis. Sensitivity and specificity of the test were evaluated using the clinical diagnosis as
the gold standard. The sensitivity of anti-CCP was 69.8% with 94.8% of specificity. For
rheumatoid factor the sensitivity was 84.5% and specificity was 74.5%. The positive
predictive value for anti-CCP was 89.3% whereas for rheumatoid factor was 67.5%.
The sensitivity and specificity of anti-CCP antibodies and rheumatoid factor was
significantly different with p-value of< 0.001. Anti-CCP antibody has a higher diagnostic specificity and positive
predictive value than rheumatoid factor, however sensitivity was lower than rheumatoid
factor.
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