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Significance of anti-CCP antibodies in modification of 1987 ACR classification criteria in diagnosis of rheumatoid arthritis
Clinical Rheumatology, 10/21/09

Zhao Jet al. – The 1987 ACR criteria have high sensitivity and specificity in established RA, but are less sensitive in early RA. The RA-6 criteria improve the sensitivity by reducing its specificity. The RA-7 criteria with replacement of rheumatoid nodules by anti-CCP antibodies increase the sensitivity without losing specificity, which may serve as new classification criteria in routine clinical practice, especially in early RA patients.

Methods

Patients who suffered from arthritic problems during the recent 2 years selected
Patients divided into RA group and non-RA group according to clinical diagnosis by experienced rheumatologists
ACR criteria revised in three ways: (1) replacement of rheumatoid nodules and erosions as criteria with anti-CCP antibodies (RA-6 criteria); (2) replacement of rheumatoid nodules with anti-CCP antibodies as a criterion (RA-7 criteria); (3) addition of anti-CCP antibodies (RA-8 criteria)
Diagnostic value of ACR criteria and anti-CCP revised criteria (RA-6, RA-7, and RA-8) evaluated by comparing sensitivity and specificity of all criteria, in all subjects and subjects with arthritis symptoms within 2 years
604 patients included in study totally, among whom 312 patients were diagnosed as RA and 292 diagnosed as other rheumatic diseases by rheumatologists

Results

For all RA patients, the sensitivity and specificity of anti-CCP antibodies were 76.2% and 96%, respectively
Its specificity much higher than RF (85.2%)
Among all RA patients, corresponding sensitivities were 92.3%, 96.8%, 94.6%, and 94.6%, and the specificities were 92.8%, 83.6%, 92.8%, and 92.8%, respectively

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