PoM No 2, 2013

Publication of the Month


February 02/13: anti-CCP testing can predict progression to rheumatoid arthritis in Sjögren’s syndrome 


Key messages:

  • Anti-CCP positive primary Sjögren's syndrome patients are likely to develop rheumatoid arthritis.

  • Testing pSS patients for anti-CCP can early predict the progression to rheumatoid arthritis  


Ryu YS, Park SH, Lee J, Kwok SK, Ju JH, Kim HY, Jeon CH
Follow-up of primary Sjögren's syndrome patients presenting positive anti-cyclic citrullinated peptides antibody
Rheumatol.Int. 2012; doi 10.I007/s00296-0I2-2572-4


In primary Sjögren's syndrome (pSS) articular manifestations belong to the most common extra-glandular manifestations. However the specific clinical characteristics and treatments of such articular manifestations, specifically, the long-term outcome and progression to rheumatoid arthritis (RA) remain unknown.

This study assessed the clinical features of pSS patients positive for anti-cyclic citrullinated peptide antibodies (anti-CCP) and the clinical significance of the anti-CCP antibody in pSS over a 60 month follow-up period.
38 of 405 pSS patients had anti-CCP (36 of them had also RF). After 60 months 23 of 405 pSS patients (5.6 %) developed RA. All 23 were positive for anti-CCP. The anti-CCP antibody titers, but not the RF titers, showed an independent association with the progression.
Patients positive for anti-CCP showed a significant higher rate of arthralgia, arthritis and progression to RA.

Because pSS patients positive for anti-CCP antibody are up to three times more likely to progress to RA, patients having arthritis and a positive anti-CCP antibody serology should be closely observed and medical treatment should be considered.

This study shows that anti-CCP is closely associated with the prevalence of arthralgia, arthritis and the progression to RA in primary Sjögren's syndrome. Therefore the measurement of anti-CCP seems to be a helpful tool to early detect progression to RA during the pSS disease course.


As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.