Antibodies against CCP (cyclic citrullinated peptide)

Specific marker for diagnosing rheumatoid arthritis

A reliable early diagnosis of rheumatoid arthritis (RA) is a prerequisite for the early treatment of this condition, which should begin as soon as possible before the onset of X-ray detectable joint damage.

The hitherto customary serodiagnosis of RA involving the determination of rheumatoid factors and CRP is not sufficient for this purpose, as rheumatoid factors are too unspecific to use as proof of this condition. (They are also indicators of other autoimmune diseases, such as SLE, Sjögren’s syndrome and others, along with infections). A certain amount of progress in RA diagnostics was achieved through the identification of filaggrin autoantibodies using immunofluorescence techniques (40-60 % positive findings for RA).
In the meantime, it has been discovered that the rare amino acid citrulline, found in filaggrin, is an integral part of the antigenic epitopes. This discovery led to the development of immunoassays (ELISA) based on cyclic citrullinated peptide (CCP) that are easier to handle.

Antibodies against CCP constitute a new, highly specific marker for rheumatoid arthritis. At the same sensitivity (anti-CCP: 80 %, RF: 79 %), antibodies against CCP exhibit a much higher specificity than the rheumatoid factor (anti-CCP: 97 %, RF: 62 %). CCP antibodies are in evidence at the very earliest stages of this condition in more than 75 % of patients and have a high prognostic value. Patients with CCP antibodies develop significantly more X-ray detectable joint damage than anti-CCP negative patients.

The anti-CCP ELISA test is suitable for the early diagnosis of rheumatoid arthritis and can thus contribute towards the timely initiation of treatment.

The identification of antibodies against CCP also makes it possible to differentiate it from other rheumatic diseases, such as SLE, Sjögren’s syndrome or dermatomyositis/polymyositis.
In the latter diseases, tests for anti-nuclear antibodies (ANA), extractable anti-nuclear antibodies (ENA) and antibodies against double-stranded DNA should be carried out.

Test material
1 ml of serum

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Reference range
< 5.0 U/ml