DIAGNOSTIC UTILITY OF ANTI-CCP, RHEUMATOID FACTOR, AND CRP IN RHEUMATOID ARTHRITIS: A PROSPECTIVE STUDY AT GEMS SRIKAKULAM, ANDHRA PRADESH.
Main Article Content
Keywords
Rheumatoid arthritis, Rheumatoid Factor, Anti CCP Antibody, C-Reactive protein
Abstract
Rheumatoid arthritis, a chronic autoimmune disease-causing joint inflammation and disability, lacks reliable standalone diagnostics. This study assesses anti-CCP antibody’s performance against RF and CRP in suspected RA patients at a tertiary care hospital in Andhra Pradesh.
Aim & Objective: To determine the utility of Anti CCP antibody in comparison with RF and CRP for diagnosis of clinically suspected patients with Rheumatoid arthritis
Methods:
A prospective analysis was conducted on 200 blood samples from patients attending Medicine and Orthopaedics OPDs over one year (Dec 2022–Nov 2023). RF was tested using latex agglutination, anti-CCP via ELISA, and CRP through standard protocols.
Results:
Majority of patients were aged 40–60 years (59%) and female (62%). Positivity rates: RF 42%, Anti-CCP Ab- 67%, CRP 57%. Notably, anti-CCP positivity was observed in 74 seronegative RA cases. Triple marker positivity (RF, anti-CCP, CRP) was seen in 26.5% of cases. Diagnostic metrics showed:
- RF vs anti-CCP: Sensitivity 70%, Specificity 81.70%, PPV 85.60%, NPV 52.70%
- Anti-CCP vs CRP: Sensitivity 83.80%, Specificity 54.40%, PPV 64.30%, NPV 77.50%
- CRP vs RF: Sensitivity 74.4%, Specificity 70.9%, PPV 67.70%, NPV 77.20%
Conclusion: Anti-CCP testing is highly sensitive and correlates with inflammation, aiding early RA diagnosis. When combined with RF and CRP, it improves diagnostic accuracy and timely care.
References
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24. Avouac, J., Gossec, L., & Dougados, M. (2006). Diagnostic and predictive value of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis: A systematic literature review. Annals of the Rheumatic Diseases, 65(7), 845–851.
25. van der Helm-van Mil, A. H., le Cessie, S., van Dongen, H., et al. (2007). A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: How to guide individual treatment decisions. Arthritis & Rheumatism, 56(2), 433–440.
26. Nell, V. P., Machold, K. P., Stamm, T. A., et al. (2005). Autoantibody profiling as early diagnostic and prognostic tool for rheumatoid arthritis. Annals of the Rheumatic Diseases, 64(12), 1731–1736.
27. Plant, M. J., Jones, P. W., Saklatvala, J., et al. (2000). Patterns of radiological progression in early rheumatoid arthritis: Results of an 8-year prospective study. The Journal of Rheumatology, (4), 902–910
28. Pruijn, G. J., Wiik, A., & van Venrooij, W. J. (2010). The use of citrullinated peptides and proteins for the diagnosis of rheumatoid arthritis. Arthritis Research & Therapy, 12(1), 203.
29. Rantapää-Dahlqvist, S., de Jong, B. A., Berglin, E., et al. (2003). Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis & Rheumatism, 48(10), 2741–2749.
2. Mehanović-Nikolić J, Laloš-Miljuš J, Stajčić-Nalesnik M, Lakić L, Bobić Ž, Bogdanić J, et al. The Diagnostic Value Of Anti Cyclic Citrullinated Peptide Antibodies, Adenosine Deaminase Activity and Other Potential Biomarkers for Predicting and MonitoringRheumatoid Arthritis. JMB. 2008;27(3)383-388.DOI: 10.2478/v10011-008-0020-5 [Crossref][PubMed][Google Scholar]
3. Kashyap B, Tiwari U, Garg A, Kaur IR. Diagnostic utility of anti CCP antibodies and rheumatoid factor as inflammatory biomarkers in comparison with C- reactive protein and TNF-α in rheumatoid arthritis. Trop J Med Res. 2015;18(1)5-9. DOI: 10.4103/1119-0388.152534 [Crossref][PubMed][Google Scholar]
4. .Arnett FC, Edworthy SM, Bloch DA, Mcshane DJ,Fries JF, Cooper NS et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3)315-24. DOI: 10.1002/art.1780310302 [Crossref][PubMed][Google Scholar]
5. Aletaha D, Neogi T, Silman AJ, Funovits J, FelsonDT, Bingham III CO, et al. Rheumatoid arthritis classification criteria: an American College ofRheumatology/European League Against
6. Rheumatism collaborative initiative. ArthritisRheum. 2010;62(9)2569-81. DOI:10.1002/art.27584 [Crossref][PubMed][GoogleScholar]
6. Banal F, Dougados M, Combescure C, Gossec L.Sensitivity and specificity of the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis according to disease durationasystematic literature review and meta-analysis.Ann Rheum Dis. 2009;68(7)1184-91. DOI:10.1136/ard.2008.093187 [Crossref][PubMed][Google Scholar]
7. Visser H. Early diagnosis of rheumatoid arthritis.Best Pract Res Clin Rheumatol. 2005;19(1)55-72.DOI: 10.1016/j.berh.2004.08.005 [Crossref][PubMed][Google Scholar]
7. Avouac J, Gossec L, Dougados M. Diagnostic andpredictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis- a systematic literature review. Ann Rheum Dis. 2006;65(7)845-51. DOI: 10.1136/ard.2006.051391
8. Masson-Bessière C, Sebbag M, Durieux JJ, et al.In the rheumatoid pannus, anti-filaggrin autoantibodies are produced by local plasma cells and constitute a higher proportion of IgG than in synovial fluid and serum. Clin Exp Immunol.2000;119(3)544-52. DOI: 10.1046/j.1365-2249 2000.01171.x [Crossref][PubMed][Google Scholar]
9. Rantapää‐Dahlqvist S, de Jong BA, Berglin E,Hallmans G, Wadell G, Stenlund H et al. Antibodies against cyclic citrullinated peptide and IgArheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum.2003;48(10)2741-9. DOI: 10.1002/art.11223 [Crossref][PubMed][Google Scholar]
10. Vallbracht I, Helmke K. Additional diagnostic and clinical value of anti-cyclic citrullinated peptide antibodies compared with rheumatoid factor isotypes in rheumatoid arthritis. Autoimmun Rev.2005;4(6)389-94
11. Lee DM, Weinblatt ME. Rheumatoid arthritis.Lancet. 2001;358(9285)903-11. DOI:10.1016/S0140-6736(01)06075-5 [Crossref] [PubMed][Google Scholar]
12. Klareskog, L., Catrina, A. I., & Paget, S. (2009). Rheumatoid arthritis. The Lancet, 373(9664), 659–672.
13. van Venrooij, W. J., van Beers, J. J., & Pruijn, G. J. (2011). Anti-CCP antibodies: The past, the present and the future. Nature Reviews Rheumatology, 7(6), 391–398
14. Aletaha, D., Neogi, T., Silman, A. J., et al. (2010). 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism, 62(9), 2569–2581
15. Ashwini Kacharu Dedwal1, AnkitaAnand2, *,Sae Satish Pol3, Renu Satish Bharadwaj RF and Anti-CCP Antibody Tests-A comparative study in the Diagnosis of Rheumatoid Arthritis in a Tertiary Care Hospital International Journal of Medical Microbiology and Tropical Diseases, October-December 2017;3(4):137-139
16. Nishimura, K., Sugiyama, D., Kogata, Y., et al. (2007). Meta-analysis: Diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Annals of Internal Medicine, 146(11), 797–808.
17. Maria D Mjaavatten*1, Désirée van der Heijde, Till Uhlig1, Anne J Haugen, Halvor Nygaard4,et al The likelihood of persistent arthritis increases withthe level of anti-citrullinated peptide antibody and immunoglobulin M rheumatoid factor: a longitudinal study of 376 patients with very early undifferentiated arthritis Mjaavatten et al. Arthritis Research & Therapy 2010, 12:R76
18. De Rycke, L., Peene, I., Hoffman, I. E., et al. (2004). Rheumatoid factor and anticitrullinated protein antibodies in rheumatoid arthritis: Diagnostic value, associations with radiological progression rate, and extra-articular manifestations. Annals of the Rheumatic Diseases, 63(12), 1587–1593.
19. Nielen, M. M., van Schaardenburg, D., Reesink, H. W., et al. (2004). Specific autoantibodies precede the symptoms of rheumatoid arthritis: A study of serial measurements in blood donors. Arthritis & Rheumatism, 50(2), 380–386.
20. Scott, D. L., Wolfe, F., & Huizinga, T. W. (2010). Rheumatoid arthritis. The Lancet, 376(9746), 1094–1108.
21. Vossenaar, E. R., Zendman, A. J., van Venrooij, W. J., & Pruijn, G. J. (2004). PAD, a growing family of citrullinating enzymes: Genes, features and involvement in disease. BioEssays, 25(11), 1106–1118.
22. Whiting, P. F., Smidt, N., Sterchi, J. A., et al. (2010). Systematic review: Accuracy of anti-citrullinated peptide antibodies for diagnosing rheumatoid arthritis. Annals of Internal Medicine, 152(7), 456–464.
23. J. Sun1, Y. Zhang1, L. Liu1, G. Liu2 Diagnostic accuracy of combined tests of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis: a meta-analysis
24. Avouac, J., Gossec, L., & Dougados, M. (2006). Diagnostic and predictive value of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis: A systematic literature review. Annals of the Rheumatic Diseases, 65(7), 845–851.
25. van der Helm-van Mil, A. H., le Cessie, S., van Dongen, H., et al. (2007). A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: How to guide individual treatment decisions. Arthritis & Rheumatism, 56(2), 433–440.
26. Nell, V. P., Machold, K. P., Stamm, T. A., et al. (2005). Autoantibody profiling as early diagnostic and prognostic tool for rheumatoid arthritis. Annals of the Rheumatic Diseases, 64(12), 1731–1736.
27. Plant, M. J., Jones, P. W., Saklatvala, J., et al. (2000). Patterns of radiological progression in early rheumatoid arthritis: Results of an 8-year prospective study. The Journal of Rheumatology, (4), 902–910
28. Pruijn, G. J., Wiik, A., & van Venrooij, W. J. (2010). The use of citrullinated peptides and proteins for the diagnosis of rheumatoid arthritis. Arthritis Research & Therapy, 12(1), 203.
29. Rantapää-Dahlqvist, S., de Jong, B. A., Berglin, E., et al. (2003). Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis & Rheumatism, 48(10), 2741–2749.
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Oct 09, 2025
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DIAGNOSTIC UTILITY OF ANTI-CCP, RHEUMATOID FACTOR, AND CRP IN RHEUMATOID ARTHRITIS: A PROSPECTIVE STUDY AT GEMS SRIKAKULAM, ANDHRA PRADESH. (2025). Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 195-204. https://doi.org/10.53555/0521yc45
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How to Cite
DIAGNOSTIC UTILITY OF ANTI-CCP, RHEUMATOID FACTOR, AND CRP IN RHEUMATOID ARTHRITIS: A PROSPECTIVE STUDY AT GEMS SRIKAKULAM, ANDHRA PRADESH. (2025). Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 195-204. https://doi.org/10.53555/0521yc45