| Systematic review: accuracy of anti-citrullinated Peptide antibodies for diagnosing rheumatoid arthritis. | |
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MedLine Citation:
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PMID: 20368651 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Early recognition and treatment of rheumatoid arthritis is important to prevent irreversible joint damage. Anti-citrullinated peptide antibodies (ACPA) have been suggested for early diagnosis. PURPOSE: To compare the accuracy of ACPA and rheumatoid factor in diagnosing rheumatoid arthritis in patients with early symptoms of the disease. DATA SOURCES: 10 medical databases from inception to September 2009, with no language or publication restrictions, and references of included studies. STUDY SELECTION: Two independent reviewers screened searches. Full articles were assessed by one reviewer and checked by a second reviewer to identify studies that reported 2 x 2 data on ACPA for the diagnosis of rheumatoid arthritis (by 1987 American College of Rheumatology criteria). DATA EXTRACTION: One reviewer abstracted data on patient characteristics, ACPA details, and 2 x 2 data and assessed study quality by using the QUADAS tool. A second reviewer checked extractions. Data SYNTHESIS: 151 studies were included, with considerable heterogeneity in sensitivity (range, 12% to 93%) and specificity (range, 63% to 100%). In cohort studies that investigated second-generation anti-cyclic citrullinated peptide antibodies (anti-CCP2) in patients with early rheumatoid arthritis (<2 years), summary sensitivity and specificity were 57% (95% CI, 51% to 63%) and 96% (CI, 93% to 97%), respectively. Case-control and cross-sectional studies and studies of patients with established rheumatoid arthritis all overestimated sensitivity. Anti-CCP2 had greater specificity than rheumatoid factor (96% vs. 86%), with similar sensitivity. Evidence was insufficient to ascertain whether the combination of anti-CCP2 and rheumatoid factor provides additional benefit over anti-CCP2 alone. LIMITATIONS: Most studies used a diagnostic case-control design, which overestimated sensitivity. Items relating to study quality were rarely reported. Publication bias could not be assessed. CONCLUSION: Anti-CCP2 should be included in the work-up of patients with early symptoms of rheumatoid arthritis. |
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Authors:
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Penny F Whiting; Nynke Smidt; Jonathan A C Sterne; Roger Harbord; Anya Burton; Margaret Burke; Rebecca Beynon; Yoav Ben-Shlomo; John Axford; Paul Dieppe |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Annals of internal medicine Volume: 152 ISSN: 1539-3704 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-04-06 Completed Date: 2010-04-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 456-64; W155-66 Citation Subset: AIM; IM |
Affiliation:
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Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom. penny.whiting@bristol.ac.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Arthritis, Rheumatoid
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diagnosis*,
immunology Autoantibodies / blood* Female Humans Male Peptides, Cyclic / immunology* Sensitivity and Specificity |
| Grant Support | |
ID/Acronym/Agency:
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//Medical Research Council |
| Chemical | |
Reg. No./Substance:
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0/Autoantibodies; 0/Peptides, Cyclic; 0/cyclic citrullinated peptide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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