A Anti-Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor and Their Association in Rheumatoid Arthritis in a Tertiary Care Hospital
Corresponding Author(s) : V G Thykadavil
drvinodgeorge@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 9 No. 2 (2021): 2021 Volume - 9 Issue - 2
Abstract
Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease of unknown etiology. Rheumatoid Factor (RF) is one of the criteria for diagnosis of RA, and there is fewer evidence for an early detection. In this study, we explored the levels of both Anti-Cyclic Citrullinated Peptide antibodies (Anti-CCP)and RF for an early diagnosis of RA before there is radiological structural changes in the joints.
Material and methods: In this prospective observational study conducted over a period of one-year, medical records of 355 subjects were evaluated. Data was compiled of Anti-CCP, RF levels, along with clinical diagnosis and other biochemical parameters. Based on clinical evaluation and serological evidence, 155 patients were diagnosed as positive cases of RA. Sensitivity and specificity were also calculated for Anti-CCP and RF.
Results: Compared to other age groups, female (72.7%) of 41-50 years (p <0.05) were significantly affected as compared to male (42%) in similar age group. Our results showed sensitivity and specificity (80.5%, 100% respectively) for Anti-CCP and that for RF was (86.1%, 96.6 respectively).Association of Anti-CCP with RF was tested using Fisher’s exact test, that showed a significant association (p?0.05).
Conclusion: There is a significant association between Anti-CCP and RF in RA patient and Anti-CCP can be used as an early and specific marker for detection of RA.
Keywords
Rheumatoid factor
Rheumatoid arthritis
Anti-Cyclic Citrullinated Peptide antibodies
Rheumatology
Low back pain
Joint pain
Fatigue
Body Ache
1.
G mamatha G, V G Thykadavil. A Anti-Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor and Their Association in Rheumatoid Arthritis in a Tertiary Care Hospital. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2021 Jun. 22 [cited 2026 Apr. 17];9(2):288-95. Available from: https://ijamscr.com/ijamscr/article/view/916
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References
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References
1.Niewold TB, Harrison MJ, Paget S. Anti-CCP antibody testing as a diagnostic and prognostic tool in rheumatoid arthritis. QJM, 2007; 100: 193-201.
2. Khan AH, Jafri L, Husain MA, Ishaq S. Diagnostic utility of anti-citrullinated protein antibody and its comparison with rheumatoid factor in rheumatoid arthritis. J Coll Physicians Surg Pak 2012;22(11):711–5.
3.Shafiaa S, Shaha ZA, Sofib FA, Rasoola R, Gulla A. Anti-CCP is associated with greater disease burden in Kashmiri population with rheumatoid arthritis. Rheumatology (Sunnyvale) 2016; 6(1):2161-1149.
4. Abdul Wahab A, Mohammad M, Rahman MM, Mohamed Said MS. Anti-cyclic citrullinated peptide antibody is a good indicator for the diagnosis of rheumatoid arthritis. Pak J Med Sci 2013;29(3):773–7.
5. Sarah K, Nadeem A. Anti-CCP Antibodies: an emerging marker for the early diagnosis of rheumatoid arthritis. Int Med J Malaysia 2010;9(1):63–5. 6.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classificationcriteria: an American College of Rheumatology/European
League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–81.
7. Bizzaro N, Bartoloni E, Morozzi G, Manganelli S, Riccieri V, Sabatini P, et al. Anti-cyclic citrullinated peptide antibody titer predicts time to rheumatoid arthritis onset in patients with undifferentiated arthritis: results from a 2-year prospective study. Arthritis Res Ther 2013;15(1):R16.
8. Anti-citrullinated protein antibodies in the diagnosis of rheumatoid arthritis (RA): diagnostic performance of automated anti-CCP-2 and anti-CCP-3 antibodies assays Clin Rheumatol 2017 36:1487–1492.
9. Schellekens GA, de Jong BA, van den Hoogen FH, van de Putte LB, van Venrooij WJ Citrulline is an essential constituent of antigenic determinants recognized by rheumatoid arthritis-specific autoantibodies. J Clin Invest 1998 101:273–281.
10. Dos Anjos LM, Pereira IA, Orsi E, Seaman AP, Burlingame RW, Morato EF A comparative study of IgG second- and third generation anti-cyclic citrullinated peptide (CCP) ELISAs and their combination with IgA third-generation CCP ELISA for the diagnosis of rheumatoid arthritis. Clin Rheumato 2009; 28:153–158.
11. Sibel A., Reyhan C et al., a new marker in Rheumatoid Arthritis- autoimmunity relation: anticyclic citrullinated peptide antibody. Turk j immunol; 2004; 9: 21-265. 12. Lipsky PE, van der Heijde DMFM, St. Clair EW, Furst DE, BreedveldFC, Kalden JR, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med 2011;343:1594–602. 13. Abdul Wahab A, Mohammad M, Rahman MM, et al. Anti-cycliccitrullinated peptide antibody is a good indicator for the diagnosis of rheumatoid arthritis. Pak J Med Sci 2013;29:773–7.
14. Chou C, Liao H, Chen C, et al. The clinical application of anti-CCP in rheumatoid arthritis and other rheumatic diseases. Biomark Insights2007;2:165–71.
15.Vencovsky J, Machacek S, Sedova L, et al. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 2003;62:427–30. 16. Porto LS, Tavares WC Junior, Costa DA, Lanna CC, Kakehasi AM. Anti-CCP antibodies are not a marker of severity in established rheumatoid arthritis: a magnetic resonance imaging study. Rev Bras Reumatol 2017;57(1):15–22. 17. Wahab MAKA, Laban AE, Hasan AA, Darweesh AF. The clinical value of anti-cyclic citrullinated peptide (anti-ccp) antibodies and insulin resistance (IR) in detection of early and subclinical atherosclerosis in rheumatoid arthritis (RA). Egypt Heart J 2016; 68(2):109–16. 18
References
References
1.Niewold TB, Harrison MJ, Paget S. Anti-CCP antibody testing as a diagnostic and prognostic tool in rheumatoid arthritis. QJM, 2007; 100: 193-201.
2. Khan AH, Jafri L, Husain MA, Ishaq S. Diagnostic utility of anti-citrullinated protein antibody and its comparison with rheumatoid factor in rheumatoid arthritis. J Coll Physicians Surg Pak 2012;22(11):711–5.
3.Shafiaa S, Shaha ZA, Sofib FA, Rasoola R, Gulla A. Anti-CCP is associated with greater disease burden in Kashmiri population with rheumatoid arthritis. Rheumatology (Sunnyvale) 2016; 6(1):2161-1149.
4. Abdul Wahab A, Mohammad M, Rahman MM, Mohamed Said MS. Anti-cyclic citrullinated peptide antibody is a good indicator for the diagnosis of rheumatoid arthritis. Pak J Med Sci 2013;29(3):773–7.
5. Sarah K, Nadeem A. Anti-CCP Antibodies: an emerging marker for the early diagnosis of rheumatoid arthritis. Int Med J Malaysia 2010;9(1):63–5. 6.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classificationcriteria: an American College of Rheumatology/European
League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–81.
7. Bizzaro N, Bartoloni E, Morozzi G, Manganelli S, Riccieri V, Sabatini P, et al. Anti-cyclic citrullinated peptide antibody titer predicts time to rheumatoid arthritis onset in patients with undifferentiated arthritis: results from a 2-year prospective study. Arthritis Res Ther 2013;15(1):R16.
8. Anti-citrullinated protein antibodies in the diagnosis of rheumatoid arthritis (RA): diagnostic performance of automated anti-CCP-2 and anti-CCP-3 antibodies assays Clin Rheumatol 2017 36:1487–1492.
9. Schellekens GA, de Jong BA, van den Hoogen FH, van de Putte LB, van Venrooij WJ Citrulline is an essential constituent of antigenic determinants recognized by rheumatoid arthritis-specific autoantibodies. J Clin Invest 1998 101:273–281.
10. Dos Anjos LM, Pereira IA, Orsi E, Seaman AP, Burlingame RW, Morato EF A comparative study of IgG second- and third generation anti-cyclic citrullinated peptide (CCP) ELISAs and their combination with IgA third-generation CCP ELISA for the diagnosis of rheumatoid arthritis. Clin Rheumato 2009; 28:153–158.
11. Sibel A., Reyhan C et al., a new marker in Rheumatoid Arthritis- autoimmunity relation: anticyclic citrullinated peptide antibody. Turk j immunol; 2004; 9: 21-265. 12. Lipsky PE, van der Heijde DMFM, St. Clair EW, Furst DE, BreedveldFC, Kalden JR, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med 2011;343:1594–602. 13. Abdul Wahab A, Mohammad M, Rahman MM, et al. Anti-cycliccitrullinated peptide antibody is a good indicator for the diagnosis of rheumatoid arthritis. Pak J Med Sci 2013;29:773–7.
14. Chou C, Liao H, Chen C, et al. The clinical application of anti-CCP in rheumatoid arthritis and other rheumatic diseases. Biomark Insights2007;2:165–71.
15.Vencovsky J, Machacek S, Sedova L, et al. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 2003;62:427–30. 16. Porto LS, Tavares WC Junior, Costa DA, Lanna CC, Kakehasi AM. Anti-CCP antibodies are not a marker of severity in established rheumatoid arthritis: a magnetic resonance imaging study. Rev Bras Reumatol 2017;57(1):15–22. 17. Wahab MAKA, Laban AE, Hasan AA, Darweesh AF. The clinical value of anti-cyclic citrullinated peptide (anti-ccp) antibodies and insulin resistance (IR) in detection of early and subclinical atherosclerosis in rheumatoid arthritis (RA). Egypt Heart J 2016; 68(2):109–16. 18
1.Niewold TB, Harrison MJ, Paget S. Anti-CCP antibody testing as a diagnostic and prognostic tool in rheumatoid arthritis. QJM, 2007; 100: 193-201.
2. Khan AH, Jafri L, Husain MA, Ishaq S. Diagnostic utility of anti-citrullinated protein antibody and its comparison with rheumatoid factor in rheumatoid arthritis. J Coll Physicians Surg Pak 2012;22(11):711–5.
3.Shafiaa S, Shaha ZA, Sofib FA, Rasoola R, Gulla A. Anti-CCP is associated with greater disease burden in Kashmiri population with rheumatoid arthritis. Rheumatology (Sunnyvale) 2016; 6(1):2161-1149.
4. Abdul Wahab A, Mohammad M, Rahman MM, Mohamed Said MS. Anti-cyclic citrullinated peptide antibody is a good indicator for the diagnosis of rheumatoid arthritis. Pak J Med Sci 2013;29(3):773–7.
5. Sarah K, Nadeem A. Anti-CCP Antibodies: an emerging marker for the early diagnosis of rheumatoid arthritis. Int Med J Malaysia 2010;9(1):63–5. 6.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classificationcriteria: an American College of Rheumatology/European
League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–81.
7. Bizzaro N, Bartoloni E, Morozzi G, Manganelli S, Riccieri V, Sabatini P, et al. Anti-cyclic citrullinated peptide antibody titer predicts time to rheumatoid arthritis onset in patients with undifferentiated arthritis: results from a 2-year prospective study. Arthritis Res Ther 2013;15(1):R16.
8. Anti-citrullinated protein antibodies in the diagnosis of rheumatoid arthritis (RA): diagnostic performance of automated anti-CCP-2 and anti-CCP-3 antibodies assays Clin Rheumatol 2017 36:1487–1492.
9. Schellekens GA, de Jong BA, van den Hoogen FH, van de Putte LB, van Venrooij WJ Citrulline is an essential constituent of antigenic determinants recognized by rheumatoid arthritis-specific autoantibodies. J Clin Invest 1998 101:273–281.
10. Dos Anjos LM, Pereira IA, Orsi E, Seaman AP, Burlingame RW, Morato EF A comparative study of IgG second- and third generation anti-cyclic citrullinated peptide (CCP) ELISAs and their combination with IgA third-generation CCP ELISA for the diagnosis of rheumatoid arthritis. Clin Rheumato 2009; 28:153–158.
11. Sibel A., Reyhan C et al., a new marker in Rheumatoid Arthritis- autoimmunity relation: anticyclic citrullinated peptide antibody. Turk j immunol; 2004; 9: 21-265. 12. Lipsky PE, van der Heijde DMFM, St. Clair EW, Furst DE, BreedveldFC, Kalden JR, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med 2011;343:1594–602. 13. Abdul Wahab A, Mohammad M, Rahman MM, et al. Anti-cycliccitrullinated peptide antibody is a good indicator for the diagnosis of rheumatoid arthritis. Pak J Med Sci 2013;29:773–7.
14. Chou C, Liao H, Chen C, et al. The clinical application of anti-CCP in rheumatoid arthritis and other rheumatic diseases. Biomark Insights2007;2:165–71.
15.Vencovsky J, Machacek S, Sedova L, et al. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 2003;62:427–30. 16. Porto LS, Tavares WC Junior, Costa DA, Lanna CC, Kakehasi AM. Anti-CCP antibodies are not a marker of severity in established rheumatoid arthritis: a magnetic resonance imaging study. Rev Bras Reumatol 2017;57(1):15–22. 17. Wahab MAKA, Laban AE, Hasan AA, Darweesh AF. The clinical value of anti-cyclic citrullinated peptide (anti-ccp) antibodies and insulin resistance (IR) in detection of early and subclinical atherosclerosis in rheumatoid arthritis (RA). Egypt Heart J 2016; 68(2):109–16. 18