Anti–Cyclic Citrullinated Peptide Antibodies in the Diagnosis of Rheumatoid Arthritis: Bayes Clears the Haze

Editorials5 June 2007Anti–Cyclic Citrullinated Peptide Antibodies in the Diagnosis of Rheumatoid Arthritis: Bayes Clears the HazeAxel Finckh, MD, MS and Matthew H. Liang, MD, MPHAxel Finckh, MD, MSFrom University Hospital of Geneva, CH-1211 Geneva 14, Switzerland, and Brigham and Women's Hospital, Boston, MA 02115.Search for more papers by this author and Matthew H. Liang, MD, MPHFrom University Hospital of Geneva, CH-1211 Geneva 14, Switzerland, and Brigham and Women's Hospital, Boston, MA 02115.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-11-200706050-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, Nishimura and colleagues review the value of testing for anti–cyclic citrullinated peptide (CCP) antibodies in the diagnosis of rheumatoid arthritis (1). Their well-done meta-analysis confirms that the presence of anti-CCP antibody is more specific than rheumatoid factor for diagnosing rheumatoid arthritis and thereby corroborates the results of 2 published systematic reviews (2, 3).The biology of this putative biomarker of rheumatoid arthritis is intriguing. Anti-CCP antibodies may be important in the pathoetiology of rheumatoid arthritis. A specific interaction between smoking and certain HLA-DR4 genes exists in patients with rheumatoid arthritis who test positive for anti-CCP antibodies (4), ...References1. Nishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakazawa T, Kawano S, et al. Meta-analysis: diagnostic accuracy of anti–cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med. 2007;146:797-808. LinkGoogle Scholar2. Riedemann JP, Muñoz S, Kavanaugh A. The use of second generation anti-CCP antibody (anti-CCP2) testing in rheumatoid arthritis—a systematic review. Clin Exp Rheumatol. 2005;23:S69-76. [PMID: 16273788] MedlineGoogle Scholar3. Avouac J, Gossec L, Dougados M. Diagnostic and predictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis. 2006;65:845-51. [PMID: 16606649] CrossrefMedlineGoogle Scholar4. Klareskog L, Stolt P, Lundberg K, Källberg H, Bengtsson C, Grunewald J, et al. A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum. 2006;54:38-46. [PMID: 16385494] CrossrefMedlineGoogle Scholar5. Kuhn KA, Kulik L, Tomooka B, Braschler KJ, Arend WP, Robinson WH, et al. Antibodies against citrullinated proteins enhance tissue injury in experimental autoimmune arthritis. J Clin Invest. 2006;116:961-73. [PMID: 16585962] CrossrefMedlineGoogle Scholar6. Rantapää-Dahlqvist S, de Jong BA, Berglin E, Hallmans G, Wadell G, Stenlund H, et al. 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Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: A meta-analysis. Arthritis Rheum. 2006;55:864-72. [PMID: 17139662] CrossrefMedlineGoogle Scholar13. Chan KW, Felson DT, Yood RA, Walker AM. The lag time between onset of symptoms and diagnosis of rheumatoid arthritis. Arthritis Rheum. 1994;37:814-20. [PMID: 8003053] CrossrefMedlineGoogle Scholar14. Quinn MA, Conaghan PG, O'Connor PJ, Karim Z, Greenstein A, Brown A, et al. Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a twelve-month randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52:27-35. [PMID: 15641102] MedlineGoogle Scholar15. Van der Bijl AE, Van der Kooij SM, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Breedveld FC, Allaart CF, et al. Persistent good clinical response after tapering and discontinuation of initial infliximab therapy in patients with early rheumatoid arthritis: 3 year results from the BEST trial [Abstract]. Presented at the Annual European Congress of Rheumatology, Amsterdam, the Netherlands, 21–24 June 2006. Ann Rheum Dis. 2006;:OP0180. Google Scholar16. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315-24. [PMID: 3358796] CrossrefMedlineGoogle Scholar17. Harrison BJ, Symmons DP, Barrett EM, Silman AJ. The performance of the 1987 ARA classification criteria for rheumatoid arthritis in a population based cohort of patients with early inflammatory polyarthritis. American Rheumatism Association. J Rheumatol. 1998;25:2324-30. [PMID: 9858425] MedlineGoogle Scholar18. Hülsemann JL, Zeidler H. Undifferentiated arthritis in an early synovitis out-patient clinic. Clin Exp Rheumatol. 1995;13:37-43. [PMID: 7774101] MedlineGoogle Scholar19. Nissilä M, Isomäki H, Kaarela K, Kiviniemi P, Martio J, Sarna S. Prognosis of inflammatory joint diseases. A three-year follow-up study. Scand J Rheumatol. 1983;12:33-8. [PMID: 6836238] CrossrefMedlineGoogle Scholar20. van der Helm-van Mil AH, le Cessie S, van Dongen H, Breedveld FC, Toes RE, Huizinga TW. A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: how to guide individual treatment decisions. Arthritis Rheum. 2007;56:433-40. [PMID: 17265478] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Axel Finckh, MD, MS; Matthew H. Liang, MD, MPHAffiliations: From University Hospital of Geneva, CH-1211 Geneva 14, Switzerland, and Brigham and Women's Hospital, Boston, MA 02115.Disclosures: None disclosed.Corresponding Author: Axel Finckh, MD, MS, Division of Rheumatology, University Hospital of Geneva, Avenue Beau-Séjour 26, CH-1211 Geneva 14, Switzerland; e-mail, axel.finckh@hcuge.ch.Current Author Addresses: Dr. Finckh: Division of Rheumatology, University Hospital of Geneva, Avenue Beau-Séjour 26, CH-1211 Geneva 14, Switzerland.Dr. Liang: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, P.B.B. 3, Boston, MA 02115. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-analysis: Diagnostic Accuracy of Anti–Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor for Rheumatoid Arthritis Kunihiro Nishimura , Daisuke Sugiyama , Yoshinori Kogata , Goh Tsuji , Takashi Nakazawa , Seiji Kawano , Katsuyasu Saigo , Akio Morinobu , Masahiro Koshiba , Karen M. 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