Anticyclic citrullinated peptide antibodies in rheumatoid and nonrheumatoid rheumatic disorders: experience with 1162 patients
Anticyclic citrullinated peptide antibodies (anti-CCP) are considered specific markers of rheumatoid arthritis (RA) and have been included in the revised classification criteria for RA diagnosis. However, these antibodies have also been detected in patients with other types of chronic inflammatory r...
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Published in | Journal of rheumatology Vol. 41; no. 12; p. 2395 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
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01.12.2014
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Abstract | Anticyclic citrullinated peptide antibodies (anti-CCP) are considered specific markers of rheumatoid arthritis (RA) and have been included in the revised classification criteria for RA diagnosis. However, these antibodies have also been detected in patients with other types of chronic inflammatory rheumatism. Our objectives were to identify the prevalence of positive anti-CCP patients in non-RA diseases, to determine the diagnostic value of anti-CCP for the diagnosis of RA, to specify the clinical characteristics of non-RA patients positive for anti-CCP, and to determine the discriminatory value of the levels of anti-CCP in patients among the various diseases.
We carried out an observational and descriptive study. All the determinations of anti-CCP requested by the 2 rheumatology departments at Cochin Hospital over a period of 18 months were analyzed. Such determinations were requested for 1162 patients in total. Anti-CCP levels were determined with the Euro Diagnostica ELISA kit, with values ≥ 25 U for this test being considered positive. The diagnosis of rheumatic conditions was the responsibility of the treating physician.
Anti-CCP antibodies were detected in 357 (30.7%) of the 1162 patients. The prevalence of anti-CCP was 292/417 (70.0%) in RA, 13/122 (10.6%) in patients with psoriatic arthritis, 13/62 (20.9%) in patients with unclassified rheumatism, 11/33 (33.3%) in patients with primary Sjögren syndrome, 5/30 (16.6%) in patients with systemic lupus erythematosus, 3/28 (10.7%) in patients with mixed connective tissue disorder, 3/36 (8.3%) in patients with systemic sclerosis, 7/44 (15.9%) in patients with juvenile arthritis, and 6/220 (2.7%) in patients with noninflammatory diseases. In the population of patients positive for anti-CCP, mean anti-CCP levels were 869.4 (± 978.4) U/ml, with no significant difference between RA [854.8 (± 959.8) U/ml] and any of the non-RA conditions [922.7 (± 1070.0) U/ml].
Anti-CCP are a hallmark of RA, but may be observed in other inflammatory, systemic, or mechanical diseases. In this large cohort of patients, the presence of second-generation anti-CCP (anti-CCP2) antibodies is useful in diagnosing RA (70% sensitivity, 91.3% specificity), but examining the levels of these antibodies does not appear to offer further discriminatory power among patients who are anti-CCP2-positive. |
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AbstractList | Anticyclic citrullinated peptide antibodies (anti-CCP) are considered specific markers of rheumatoid arthritis (RA) and have been included in the revised classification criteria for RA diagnosis. However, these antibodies have also been detected in patients with other types of chronic inflammatory rheumatism. Our objectives were to identify the prevalence of positive anti-CCP patients in non-RA diseases, to determine the diagnostic value of anti-CCP for the diagnosis of RA, to specify the clinical characteristics of non-RA patients positive for anti-CCP, and to determine the discriminatory value of the levels of anti-CCP in patients among the various diseases.
We carried out an observational and descriptive study. All the determinations of anti-CCP requested by the 2 rheumatology departments at Cochin Hospital over a period of 18 months were analyzed. Such determinations were requested for 1162 patients in total. Anti-CCP levels were determined with the Euro Diagnostica ELISA kit, with values ≥ 25 U for this test being considered positive. The diagnosis of rheumatic conditions was the responsibility of the treating physician.
Anti-CCP antibodies were detected in 357 (30.7%) of the 1162 patients. The prevalence of anti-CCP was 292/417 (70.0%) in RA, 13/122 (10.6%) in patients with psoriatic arthritis, 13/62 (20.9%) in patients with unclassified rheumatism, 11/33 (33.3%) in patients with primary Sjögren syndrome, 5/30 (16.6%) in patients with systemic lupus erythematosus, 3/28 (10.7%) in patients with mixed connective tissue disorder, 3/36 (8.3%) in patients with systemic sclerosis, 7/44 (15.9%) in patients with juvenile arthritis, and 6/220 (2.7%) in patients with noninflammatory diseases. In the population of patients positive for anti-CCP, mean anti-CCP levels were 869.4 (± 978.4) U/ml, with no significant difference between RA [854.8 (± 959.8) U/ml] and any of the non-RA conditions [922.7 (± 1070.0) U/ml].
Anti-CCP are a hallmark of RA, but may be observed in other inflammatory, systemic, or mechanical diseases. In this large cohort of patients, the presence of second-generation anti-CCP (anti-CCP2) antibodies is useful in diagnosing RA (70% sensitivity, 91.3% specificity), but examining the levels of these antibodies does not appear to offer further discriminatory power among patients who are anti-CCP2-positive. |
Author | Avouac, Jérôme Dougados, Maxime Allanore, Yannick Kahan, André Payet, Judith Batteux, Frédéric Goulvestre, Claire Bialé, Lisa Wipff, Julien Job-Deslandre, Chantal |
Author_xml | – sequence: 1 givenname: Judith surname: Payet fullname: Payet, Judith email: judith.payet@cch.aphp.fr organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital. judith.payet@cch.aphp.fr – sequence: 2 givenname: Claire surname: Goulvestre fullname: Goulvestre, Claire organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital – sequence: 3 givenname: Lisa surname: Bialé fullname: Bialé, Lisa organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital – sequence: 4 givenname: Jérôme surname: Avouac fullname: Avouac, Jérôme organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital – sequence: 5 givenname: Julien surname: Wipff fullname: Wipff, Julien organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital – sequence: 6 givenname: Chantal surname: Job-Deslandre fullname: Job-Deslandre, Chantal organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital – sequence: 7 givenname: Frédéric surname: Batteux fullname: Batteux, Frédéric organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital – sequence: 8 givenname: Maxime surname: Dougados fullname: Dougados, Maxime organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital – sequence: 9 givenname: André surname: Kahan fullname: Kahan, André organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital – sequence: 10 givenname: Yannick surname: Allanore fullname: Allanore, Yannick organization: From Paris Descartes University, Cochin Hospital, Rheumatology A and Rheumatology B, and Immunology Laboratory, Paris, France.J. Payet, MD, Rheumatology A; J. Avouac, PhD, Rheumatology A; J. Wipff, MD, Rheumatology A; C. Job-Deslandre, MD, Rheumatology A; A. Kahan, PhD, Rheumatology A; Y. Allanore, PhD, Rheumatology A; C. Goulvestre, MD, Immunology Laboratory; F. Batteux, MD, Immunology Laboratory; L. Bialé, MD, Rheumatology B; M. Dougados, MD, Rheumatology B, Paris Descartes University, Cochin Hospital |
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References | 25729050 - J Rheumatol. 2015 Mar;42(3):558 26034235 - J Rheumatol. 2015 Jun;42(6):1063-4 25452177 - J Rheumatol. 2014 Dec;41(12):2340-2 |
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SubjectTerms | Adult Aged Antibodies, Anti-Idiotypic - blood Arthritis, Juvenile - blood Arthritis, Juvenile - diagnosis Arthritis, Juvenile - immunology Arthritis, Psoriatic - blood Arthritis, Psoriatic - diagnosis Arthritis, Psoriatic - immunology Arthritis, Rheumatoid - blood Arthritis, Rheumatoid - diagnosis Arthritis, Rheumatoid - immunology Biomarkers - blood Diagnosis, Differential Female Humans Lupus Erythematosus, Systemic - blood Lupus Erythematosus, Systemic - diagnosis Lupus Erythematosus, Systemic - immunology Male Middle Aged Mixed Connective Tissue Disease - blood Mixed Connective Tissue Disease - diagnosis Mixed Connective Tissue Disease - immunology Peptides, Cyclic - immunology Retrospective Studies Rheumatic Diseases - blood Rheumatic Diseases - diagnosis Rheumatic Diseases - immunology Scleroderma, Systemic - blood Scleroderma, Systemic - diagnosis Scleroderma, Systemic - immunology Sensitivity and Specificity Sjogren's Syndrome - blood Sjogren's Syndrome - diagnosis Sjogren's Syndrome - immunology |
Title | Anticyclic citrullinated peptide antibodies in rheumatoid and nonrheumatoid rheumatic disorders: experience with 1162 patients |
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