Title: Role in the diagnosis and prognosis of rheumatoid arthritis RA
1Anti-cyclic citrullinated peptide (CCP) antibodies
Dr. N. Pipitone Dipartimento Area Medica I Unità
Operativa di Reumatologia Direttore Dr. C.
Salvarani
- Role in the diagnosis and prognosis of rheumatoid
arthritis (RA)
2Points
- Definition
- Role in diagnosing RA
- Prognostic role in RA
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4Clin Exp Immunol 2004135173
5Anti-CCP
- citrullinated
- cyclic
- peptide
6Points
- Definition
- Role in diagnosing RA
- Prognostic role in RA
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8Newer anti-CCP (anti-CCP2)
- Meta-analysis of anti-CCP2 in 1117 RA patients
and 1845 diseased controls (Clin Appl Immunol Rev
20044239 ) - Sensitivity 77, specificity 96.1
Rheumatoid factor
- Sensitivity 72
- Specificity 80
Ann Rheum Dis 200362870-874
9Anti-CCP remain stable over time
- After 3 years, only 5/97 RA patients (ACR
criteria) changed anti-CCP status (2 from ve to
ve) - In the elderly, lt0.3 are ve for anti-CCP
10anti-CCP in RF-associated diseases
- 50 patients with HCV infection without
cryoglobulinemia - 29 patients with mixed cryoglobulinemia (5 of
whom with arthritis) - 20 normal blood donors
- ELISA Inova Diagnostic, serum dilution of 1100
CV of 10-15, upper limit 20 U/ml
Arthritis Rheum 2004 50(7)2305
11Arthritis Rheum 2004 50(7)2305
12Anti-CCP in primary Sjøgrens syndrome
- 134 patients with a primary Sjögrens syndrome
(EU/US consensus criteria) - None fulfilled the ACR criteria for RA
- Long disease duration (ca. 10 years)
- Eurodiagnostica kit (ve gt50 U/ml)
- 7.5 (10 patients) ve for anti-CCP (8 cases)
5.9 gt100 U - 9/10 patients with ve anti-CCP had non-erosive
arthritis
Annals of the Rheumatic Diseases 200564114-117
13Anti-CCP in Psoriatic Arthritis
- Serum samples of 192 PsA patients
- Test EuroDiagnostica ELISA
- Cut-off at a specificity-level of gt/ 98.5 (42
U/ml) - Anti-CCP antibodies were found in 15/192 (7.8)
patients. Thirteen samples of 15 patients with
anti-CCP2 were also positive for anti-pepA or
pepB antibodies.
Vander Cruyssen B Ann Rheum Dis. 2005
14Anti-CCP in RA and non-RA rheumatic diseases
Ann Rheum Dis 200362870-874
15Points
- Definition
- Role in diagnosing RA
- Prognostic role in RA
16Anti-CCP and disease course
- 242 patients with lt1 year onset RA (clinical Dx)
- F/up 3 yrs
- Outcome variables (at different time points)
- ESR, CRP
- DAS 28
- PGA
- HAQ
- anti-CCP2 (Euro-Diagnostica, cut-off 25 U/ml)
Kastbom A et al, Ann Rheum Dis 2004631085
17Kastbom A et al, Ann Rheum Dis 2004631085
18Anti-CCP and erosions in RA
Lee Schur, ARD 2003
19Patients description
- Pain (VAS 0-100) 57.5 ? 22
- EMS (min) 84.9 ? 79.4
- TJC 21.7 ? 10.5
- SJC 9.0 ? 5.9
- ESR 40.2 ? 28.5
- Values are mean ? SD
Meyer, Annals of the Rheumatic Diseases
200362120
20Meyer, Annals of the Rheumatic Diseases
200362120
21Titer
Our own, still incomplete and unpublished data
seem to indicate that high titers of anti-CCP (gt5
times cut-off) correlate somewhat more strongly
with erosive disease than lower titers.
Antibodies to cyclic citrullinated peptides are
specific for the diagnosis and prognosis of
(early) rheumatoid arthritis Walther J. van
Venrooij, Albert J.W. Zendman, Suzanne
Nijenhuis,Erik R. Vossenaar, Allan Wiik, and Ger
J.M. Pruijn Elia Journal, November 2004
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