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Serotyping for an extended anti-citrullinated peptide autoantibody panel does not add value to CCP2 testing for diagnosing RA in an early undifferentiated arthritis cohort
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Dr Arthur Pratt
Professor John Isaacs
Pratt AG, Charles PJ, Chowdhury M, Wilson G, Venables PJ, Isaacs JD
Annals of the Rheumatic Diseases
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The now widely employed CCP2 assay, which detects circulating autoantibodies to a panel of synthetic, cyclic citrullinated peptides, carries a positive predictive value of 0.93 for rheumatoid arthritis (RA) among early undifferentiated arthritis (UA) patients, 1 thus providing a cornerstone of recently evolved scoring systems that predict and classify early RA. 2 However, approximately 80% of newly presenting UA patients are anti-CCP2- negative 3 and a quarter of these evolve into RA within 3 years, 1 thus experiencing diagnostic delay. The peptides used in the CCP2 assay do not necessarily correspond to in vivo generated proteins, yet citrullinated antigens of putative pathophysiological relevance have recently been described in association with specific circulating autoantibodies in RA. 4 Therefore, we hypothesised that the detection of one or any such autoantibodies, as well as those against filaggrin components of the CCP1 assay, 5 IgA or IgM rheumatoid factor (RF), might add to the diagnostic utility of CCP2 testing alone in predicting RA progression among early UA patients.
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