Anti- Cyclic Citrullinated Peptide Antibodies: Clinical utility and their role as early prognostic markers in Erosive Rheumatoid Arthritis.

Abstract

Objectives: To assess the diagnosticutilityofanti- cyclic citrullinated protein antibody (anti-CCP) in comparison to rheumatoid factor (RF) in diagnosis of rheumatoid arthritis (RA) and to determine its prognostic value in erosive rheumatoid arthritis. Materials and Methods: The study included 60 patients with clinically suspected RA. Anti-CCPwas measured by enzyme-linked immunosorbent assay (ELISA) and rheumatoid factor (RF) by nephalometry. The seropositivity with RF and ACCP antibodies were studied in comparison with radiographic changes and joint symptoms which included presence and duration of joint involvement- multiple joints, small joints, symmetric joints, stiffness or swelling of joints. Results: Among the 60 patients, the mean age for RA was found to be 43 years. A higher seropositivity was found among the females. The sensitivity and specificity ofanti-CCPreactivity for the diagnosis of RAwere 38.3 and 100 respectively. Among the symptoms studied, small joint involvement and involvement of multiple joints showed a positive association with serologically positive individuals. Patients with high anti-CCP antibody titres showed higher RF titres and severe radiographic erosions. Conclusion: Anti CCP antibodies are a highly specific for rheumatoid arthritis. A combined diagnosis using both high titers ofanti-CCPantibodiesand a positive RF test markedly improvesRAdiagnostic specificity. ACCP antibody detection helps in early diagnosis as well as detection of progressive joint damage.