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Is It Time to Set This Genie Free?

Robert H. Shmerling, MD

Arch Intern Med. 2009;169(1):9-14.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In recent years, a new class of autoantibodies associated with rheumatoid arthritis (RA) has been described and increasingly used as a diagnostic test.^1-8 These antibodies, including anti–perinuclear factor and antifilaggrin antibodies target citrulline, a modified form of arginine produced through the action of peptidyl-arginine-deaminase. By consensus, these antibodies are now called anti–cyclic citrullinated peptide (anti-CCP) antibodies. For patients meeting classification criteria for RA, the anti-CCP antibody test (hereafter, anti-CCP test) has a reported sensitivity (frequency of positive results in the presence of disease) of 50% to 70% and specificity (frequency of negative results in the absence of disease) of 95% to 98%.^1-7 Some of the variation in sensitivity and specificity across studies may be related to newer generations of the test measuring different antibody subtypes.⁷ A recent meta-analysis reported the sensitivity and specificity of the anti-CCP test for RA as 67% and 95%, respectively.⁸

These findings, . . . [Full Text of this Article]

THE STRENGTHS OF ANTI-CCP TESTING


ANTI-CCP TESTING FOR THE DIAGNOSIS OF RA: THE CASE FOR CAUTION

PATIENTS WITH NEW OR ESTABLISHED RA

CAN AUTOANTIBODY STATUS BE HELPFUL IN DIRECTING RA THERAPY?

PATIENTS WITH EARLY ARTHRITIS

PATIENTS WITH ARTHRALGIA BUT WITHOUT POLYARTHRITIS

THE IMPORTANCE OF PRETEST PROBABILITY

OTHER CLINICAL SCENARIOS WHEN ANTI-CCP TESTING MAY BE HELPFUL

PATIENTS WITH INFLAMMATORY CONDITIONS SUGGESTIVE OF SYSTEMIC RHEUMATIC DISEASE

WHAT IF AN ANTI-CCP TEST IS ORDERED INSTEAD OF AN RF TEST?

WHAT IF AN ANTI-CCP TEST IS ORDERED IN ADDITION TO AN RF TEST?
ANTI-CCP TEST RESULTS WHEN THE RF TEST RESULT IS POSITIVE

ANTI-CCP TEST RESULTS WHEN THE RF TEST RESULT IS NEGATIVE

WHAT ABOUT COST?

WOULD DELAYS IN TESTING FOR ANTI-CCP ANTIBODIES DELAY THE DIAGNOSIS OF RA?

CONCLUSIONS

AUTHOR INFORMATION


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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Anti-Cyclic Citrullinated Peptide in Preclinical Rheumatoid Arthritis. Food for Thought
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