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The use of second generation anti-CCP antibody (anti-CCP2) testing in rheumatoid arthritis – A systematic review

J.P. Riedemann¹, S. Muñoz², A. Kavanaugh³

¹Department of Rheumatology and Clinical Epidemiology, ²CIGES, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile; ³Center for Innovative Therapy, UCSD, Division of Rheumatology, Allergy and Immunology, La Jolla, California, USA.

ABSTRACT
Objective
To evaluate the diagnostic properties and predictive value of the second generation of anti-CCP antibodies (anti-CCP2) in rheumatoid arthritis (RA) patients.

Methods
A systematic review of the published literature between January 2002 and June 2005 was performed. Data were extracted regarding the sensitivity and specificity of anti-CCP2 antibodies in making an accurate diagnosis of RA, predicting future development of RA, and predicting future radiological damage in RA patients. In addition, the prevalence of CCP2 antibodies in patients with other rheumatic diseases was examined.

Results
Among 38 studies initially identified, 27 provided information on the use of anti-CCP2 testing. Diagnostic properties were assessed in 13 studies; reported sensitivities ranged from 14.4% to 96%, and specificities from 88.9% to 100%. Odds ratios (OR) for the future development of RA varied from 15.9 among previously healthy individuals to 37.8 among a group of patients with undifferentiated arthritis. Several studies suggested that the presence of anti-CCP2 antibodies is highly predictive of current radiographic damage and further damage progression.

Conclusions
Anti-CCP2 has a low sensitivity to be used as a screening test. However, a positive test is highly specific for RA. In addition, anti-CCP2 appears to be highly predictive of the future development of RA in both normal individuals and patients with undifferentiated arthritis. Finally, the presence of anti-CCP2 antibodies appears to predict radiographic damage and progression among patients with RA.

Key words
Rheumatoid arthritis, diagnosis, anti-CCP2 antibodies, systematic review.

Please address correspondence to Prof. J. Pablo Riedemann, MD.
E-mail: riedeman@ufro.cl