The diagnostic utility of the anti-CCP antibody test is no better than rheumatoid factor in South Africans with early rheumatoid arthritis

Clinical Rheumatology - Tập 29 - Trang 615-618 - 2010
Bridget Hodkinson1, Pieter W. A. Meyer2, Eustasius Musenge3, Mahmood M. T. Ally4, Ahmed A. Wadee5, Ronald Anderson2, Mohammed Tikly1
1Division of Rheumatology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
2Department of Immunology, Medical Research Council Unit for Inflammation and Immunity, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa
3Epidemiology Centre, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
4Department Internal Medicine, Steve Biko Pretoria Academic Hospital and University of Pretoria, Pretoria, South Africa
5Division of Immunology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa

Tóm tắt

To establish the diagnostic utility of the anti-cyclic-citrullinated peptide antibody (aCCP) test in Black South Africans with early rheumatoid arthritis (RA). A cross-sectional study comparing the rheumatoid factor (RF) and aCCP status in RA patients and a control group consisting of healthy subjects, and patients with systemic lupus erythematosus (SLE) and scleroderma. The sensitivity, specificity, positive (PPV) and negative predictive values of the aCCP test alone were 82.5%, 84.9%, 87.6% and 79% versus 81.7%, 90.7%, 92.5% and 78% for RF alone. The best specificity (95.3) and PPV (95.8%) was observed when both aCCP and RF tests were positive. Patients with erosive disease had a significantly higher mean RF titre compared with those with non-erosive disease (p = 0.007). There was a trend towards an association of smoking (OR = 4.1, 95% CI = 0.9–18.6) and functional disability (p = 0.07) with RF-positive status. No similar clinical associations were observed with aCCP. Almost a third of SLE patients were aCCP positive. Despite the best specificity and PPV observed when both the aCCP and RF tests were positive, our findings suggest that testing for aCCP is only cost-effective in the RF-negative patient in whom there is a strong clinical suspicion of RA.

Tài liệu tham khảo

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