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Anti-CCP antibody?

What is Anti-CCP antibody?
Anti CCP antibody stands for anti-cyclic citrullinated peptide antibody. It is a protein produced as part of the process that leads to joint inflammation in rheumatoid arthritis. It is a test used to confirm the diagnosis of rheumatoid arthritis. At present, anti- CCP antibody is the most specific marker for Rheumatoid arthritis. With a specificity of about 98%, it is a reliable marker to confirm the diagnosis of Rheumatoid arthritis. Schellekens, G.A was the first to show that patients suffering from rheumatoid arthritis produce antibodies to peptides or proteins containing citrulline in 1998.
What is the utility of anti-CCP antibody test?
Anti CCP is a very useful blood test in the diagnosis of Rheumatoid arthritis. It scores over the routine rheumatoid factor test for early & spcific diagnosis of rheumatoid arthritis*

Anti CCP antibody is also of prognostic significance in Rheumatoid arthritis. High levels of the antibody indicate a more aggressive RA & higher risk of joint damage as compared to a patient with low levels**

Interestingly, anti CCP antibodies predate the diagnosis of RA & may be found years before symptoms of RA develop. They are believed to have a pathogenic role in development of RA, but are not obligatory for the same.
Is anti CCP antiboy test better than Rheumatoid factor test?
Yes. Anti CCP antibody is more reliabkle than Rheumatoid factor in diagnosing Rheumatoid arthritis. Anti CCP test can accurately diagnose Rheumatoid Arthritis at a very early stage as compared to rheumatoid factor. An earlier diagnosis would mean early institution of DMARDs & higher chances of remission.
Does a negative anti CCP rule out Rheumatoid Arthritis?
No. A negative anti CCP does not completely rule out Rheumatoid Arthritis.
How reliable is Anti CCP antibody in the diagnosis of Rheumatoid arthritis?
Anti CCP antibody is a very reliable marker for RA. The specificity of 1st generation anti CCP assay for RA was 65-70%. With further research & refinement of the processes involved in anti CCP antibody detection, 2nd generation anti CCP kits evolved. The specificity of the 2nd generation anti CCP assay, is almost 96-98%.
Can Anti CCP antibody predict development of Rheumatoid Arthritis in relatives of patients with it?
Yes. Anti CCP antibody is positive in 48% of the first-degree relatives of patients with Rheumatoid Arthritis. The incidence increases with smoking. Those with positive anti CCP antibody are at higher risk of developing Rheumatoid Arthritis.

* *Meta-analysis: Diagnostic Accuracy of Anti–Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor for Rheumatoid Arthritis K. Nishimura, D. Sugiyama, Y. Kogata, G. Tsuji, T. Nakazawa, S. Kawano, K. Saigo, A. Morinobu, M. Koshiba, K. M. Kuntz, I. Kamae and S. Kumagai  Ann Intern Med 2007; 797-808
**Kastbom, A., Strandberg, G., Lindroos, A. et al. 2004. Anti-CCP antibody test predicts the disease course during 3 years in early rheumatoid arthritis (the Swedish TIRA project). Ann. Rheum. Dis.,63:1085–9.
Anti–Citrullinated Protein Antibodies in Unaffected First-Degree Relatives of Rheumatoid Arthritis Patients. Lillian Barra et al Arthritis & Rheumatism Volume 65, Issue 6, pages 1439–1447, June 2013

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Created on: April 2007
Last updated on: Feb 2015
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