Diagnostic usefulness of a third-generation anti-cyclic citrulline antibody test in patients with recent-onset polyarthritis.

BACKGROUND: The high specificity of anti-cyclic citrullinated peptide antibodies (anti-CCP) helps substantially in the diagnosis of rheumatoid arthritis (RA), combined with classical markers such as rheumatoid factor (RF). The recent introduction of third-generation methods (anti-CCP3) for anti-CCP detection could further improve diagnostic efficiency. The aim of this study was to determinate the diagnostic efficiency (sensitivity and specificity) of anti-CCP using a new anti-CCP3 method and to compare it with the previous second-generation method (anti-CCP2). METHODS: Anti-CCP were studied in sera of 234 patients with recent-onset polyarthritis (ROP) (age > or =16 years; evolution time > or =4 weeks < or =1 year; 2 or more inflamed joints, without drug therapy). After 1 year, 124 patients were diagnosed with RA (American College of Rheumatology criteria). Two ELISAs, an anti-CCP2 and an anti-CCP3, were performed. RESULTS: The best sensitivity according to receiver operating characteristic curves was 51.5% and 54.8% for anti-CCP3 and anti-CCP2, with a specificity of 96.2% and 98.1%, respectively (optimal cutoffs 14.2 and 18.7 U/mL). Significant correlations were obtained (p<0.001) when the methods were compared to each other and to RF. CONCLUSIONS: Testing with both types of anti-CCP kit is highly specific for the presence of RA. In our ROP group, anti-CCP2 and anti-CCP3 exhibited similar diagnostic efficiency.