A Comparative Evaluation of the Diagnostic Value of Anti-cyclic Citrullinated Peptide and Rheumatoid Factor in Rheumatoid Arthritis

Objective This meta-analysis explored the diagnostic value of anti-cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor (RF) for rheumatoid arthritis (RA) in the Asian population. Methods Embase, Medline, Cochrane Library, Chinese Science and Technology Periodicals, China National Knowledge Infrastructure, and China Wanfang Databases were searched from 1 January 2000 to 1 February 2021 to collect studies on the combined detection of anti-CCP and RF for diagnosing RA. The sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (+LR), and negative likelihood ratio (−LR) were combined and analyzed. Summary receiver operating characteristic (SROC) curves were drawn. Results Twenty-four published papers were analyzed, including 21 combined in series and 8 combined in parallel. In the tandem analysis, the sensitivity = 0.64 [95% confidence interval (CI): 0.58–0.70], specificity = 0.97 (95%CI: 0.95–0.98), +LR = 19.70 (95%CI: 12.74–30.46), −LR = 0.37 (95%CI: 0.31–0.43), DOR = 53.43 (95%CI: 34.46–82.40), and area under the SROC curve = 0.89. In the parallel combination, the sensitivity = 0.87 (95%CI: 0.80–0.92), specificity = 0.76 (95%CI: 0.67–0.84), +LR = 3.68 (95%CI: 2.62–5.17), −LR = 0.17 (95%CI: 0.11–0.26), DOR = 21.56 (95%CI: 11.63–39.99), and area under the SROC curve = 0.89. Conclusion Anti-CCP and RF combined detection improves the diagnostic efficiency of RA, providing a potential strategy for early clinical screening in the Asian population. This trial was retrospectively registered in the INPLASY/Research Registry ( https: //inplasy.com/ ) with the registration number INPLASY202180106.

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Anti-cyclic citrullinated peptide antibodies and rheumatoid factor in Rheumatoid Arthritis

ACTUALIDAD MEDICA ◽

10.15568/am.2021.813.or02 ◽

2021 ◽

Vol 106 (106(813)) ◽

pp. 157-164

Author(s):

R. Clavero-López ◽

A.I. Navarro-Abad ◽

M. Ruiz-Herance ◽

J.M. Urra-Ardanaz

Keyword(s):

Rheumatoid Arthritis ◽

Rheumatoid Factor ◽

Pharmacological Treatment ◽

Test Validity ◽

Reference Value ◽

Diagnostic Value ◽

Definitive Diagnosis ◽

Cyclic Citrullinated Peptide ◽

Citrullinated Peptide ◽

Peptide Antibodies

Introduction: For the diagnosis of Rheumatoid Arthritis (RA), the detection of the autoantibodies, rheumatoid factor (FR) and cyclic citrullinated peptide antibodies (APCC) are used. The presence of these antibodies determines that the RA is classified as seropositive or seronegative, with important implications both in the clinical development and in the prognosis of the disease. Objective: To assess the role of APCC and RF in the diagnosis of RA, as well as its influence on the establishment of pharmacological treatment. Methodology: We studied 213 patients with initial clinical suspicion of RA and with determinations of FR and APCC. Their definitive diagnosis and the pharmacological treatment established were studied. Results: 63 of 213 patients had a definitive diagnosis of RA. 77.8% were classified as seropositive. The sensitivity and specificity were higher in the APCC compared to FR. Initially the RF presented a low diagnostic value since it was negative in more than two thirds of the patients with a diagnosis of RA. The precise adjustment of its reference value allowed its use as a useful diagnostic tool. The presence of antibodies in patients with RA influences the treatment of choice with an increased use of Methotrexate against other immunosuppressants in seropositive patients. Conclusions: The APCC presented better parameters of diagnostic test validity than the RF. The presence of antibodies in RA influences the treatment of choice possibly due to the greater severity of the pathology.

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