Document Detail


Rheumatoid factor and antibodies to cyclic citrullinated Peptide differentiate rheumatoid arthritis from undifferentiated polyarthritis in patients with early arthritis.
MedLine Citation:
PMID:  12375314     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To study the diagnostic value of IgM rheumatoid factor (RF), IgA-RF, antibodies to cyclic citrullinated peptide (anti-CCP), and combinations of these antibodies, measured at baseline, to discriminate rheumatoid arthritis (RA) from undifferentiated polyarthritis (uPA) in patients with recent onset arthritis. METHODS: Patients with early arthritis with peripheral arthritis of 2 or more joints and symptom duration less than 3 years were clinically diagnosed as having RA or uPA by an experienced rheumatologist during the first year. Patients with bacterial, psoriatic, or crystal induced arthritis or spondyloarthropathy were excluded. Optimal cutoff values for serum IgM RF, IgA RF, and anti-CCP were deduced from receiver operating characteristics curves in order to predict the diagnosis of RA in early arthritis. RESULTS: A total of 379 patients (69% female, median age 57 yrs, range 17-86 yrs) were studied; 258 patients were clinically diagnosed as RA and 121 as uPA. Both IgM-RF > 40 IU/ml and anti-CCP > 50 AU/ml showed high specificity, but the sensitivity of these tests was low. In many RA patients the occurrence of IgM-RF and anti-CCP antibodies was independent. Thus the optimal criterion proved to be the combination of IgM-RF > 40 or anti-CCP > 50, which yielded sensitivity of 55.4% and specificity of 96.7%. CONCLUSION: The criterion IgM-RF > 40 or anti-CCP > 50 is able to predict the diagnosis of RA in early arthritis patients with high specificity and acceptable sensitivity. Anti-CCP testing combined with IgM-RF testing has additional value over IgM-RF testing alone in patients with early undifferentiated oligo and polyarthritis.
Authors:
Annemarie L M A Jansen; Irene van der Horst-Bruinsma; Dirkjan van Schaardenburg; Rob J van de Stadt; Margret H M T de Koning; Ben A C Dijkmans
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of rheumatology     Volume:  29     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-10     Completed Date:  2003-02-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  2074-6     Citation Subset:  IM    
Affiliation:
Jan van Breemen Instituut and the Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Arthritis, Rheumatoid / diagnosis*,  immunology*
Autoantibodies / immunology*
Citrulline / immunology*
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Outpatients
Peptides, Cyclic / immunology
Rheumatoid Factor / blood*
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Autoantibodies; 0/Peptides, Cyclic; 372-75-8/Citrulline; 9009-79-4/Rheumatoid Factor
Comments/Corrections
Comment In:
J Rheumatol. 2002 Oct;29(10):2034-40   [PMID:  12375308 ]

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