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Anti-CCP antibody, RF positivity helped to establish RA diagnosis
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Positive anti-cyclic citrullinated peptide antibody and positive rheumatoid factor combined were more effective in diagnosing rheumatoid arthritis when compared with only one of the two factors being positive, according to meta-analysis results.
Researchers in China conducted a literature search from January 2000 to January 2013 of the Medline database to determine the diagnostic properties of combined tests of anti-cyclic citrullinated peptide (anti-CCP) antibody and rheumatoid factor (RF) for diagnosing rheumatoid arthritis (RA). Search terms included “rheumatoid arthritis, anti-CCP antibody, rheumatoid factor, RF, RA, ACPA, diagnostic accuracy, sensitivity” and “specificity.”
From 1,009 studies identified, 24 met inclusion criteria and were contained in the final analysis. Threshold effect analysis and meta-regression were used to evaluate heterogeneity among the studies.
“When both anti-CCP antibody and RF were positive, the included studies showed excellent specificities that varied moderately,” the researchers reported.
Anti-CCP antibody and RF positivity (both markers positive) had the following summary estimates in diagnosing RA: sensitivity, 57% (95% CI, 55%-59%); specificity, 96% (95% CI, 96%-97%), positive likelihood ratio (LR), 13.84 (95% CI, 10.56-18.12); negative LR, 0.46 (95% CI, 0.4-0.52); and diagnostic odds ratio (DOR), 33.02 (95% CI, 23.89-45.64). In pooled data where one serum marker had to be positive, summary estimates were: sensitivity, 78% (95% CI, 76%-80%); specificity, 82% (95% CI, 81%-84%), positive LR, 4.24 (95% CI, 3.61-4.97), negative LR, 0.27 (95% CI, 0.22-0.34); and DOR, 16.95 (95% CI, 12.96-22.18).
“Positivity for anti-CCP and RF combined are useful for establishing the diagnosis of RA, especially in the early stage of the disease,” the researchers concluded. “The combined positivity maximizes the probability of true positivity in classifying RA. Because of the decreased diagnostic accuracy, positivity for anti-CCP antibody or RF should be incorporated with other examinations to make a final diagnosis.”
Disclosure: The researchers report no relevant financial disclosures.
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