CCP Antibodies  |  Rheumatoid Factor

CCP Antibodies

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Performance Characteristics
EliA CCP (pdf)

Antigens

From the detailed studies of citrullinated filaggrin peptides by Schellekens et al. in 1998 it became apparent that different RA patients recognise different citrullinated peptides. In cyclic variants of these peptides the citrulline residue is optimally exposed for antibody binding. At the end of 2000, an anti-CCP assay with novel cyclic peptides, which were most reactive with RA sera, and improved performance characteristics was introduced as "second generation CCP (CCP2)" and made commercially available as an ELISA assay.

EliA CCP is based on the CCP2 test.

Antibody specificity and prevalence

Anti-CCP are highly specific for Rheumatoid Arthritis (RA). In an internal study, EliA CCP showed an outstanding sensitivity of 87.8 % and a specificity of 96.9 %.

Several studies show that the CCP test enables clinicians to effectively distinguish RA patients from other RA-resembling diseases, even in cases where the rheumatoid factor is not discriminative. Anti-CCP antibodies can be detected very early in the course of RA.

Information about Rheumatoid Arthritis

Disease activity

The presence of anti-CCP is associated with significantly higher levels of erosions compared to rheumatoid factor and other parameters. Anti-CCP is an independent predictor of radiological damage and progression.

When is the measurement recommended?

Suspicion of Rheumatoid Arthritis.

Antibody isotypes

IgG

References

• Schellekens GA, de Jong BA, van den Hoogen FH, et al. (1998) Citrulline is an essential constituent of antigenic determinants recognized by rheumatoid arthritis-specific autoantibodies. J Clin Invest 101, 273-281
• Rantapää-Dahlqvist S, de Jong BA, Berglin E, et al. (2003) Antibodies against citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum 48, 2741-2749
• Van Gaalen FA, Linn-Rasker SP, van Venrooij WJ, et al. (2004) Autoantibodies to cyclic citrullinated peptides (CCP) predict progression to rheumatoid arthritis in patients with undifferentiated arthritis: a prospective cohort study. Arthritis Rheum 50, 709-715
• Forslind K, Ahlmén M, Eberhardt K, et al. (2004) Prediction of radiological outcome in early RA in clinical practice: role of antibodies to citrullinated peptides (anti-CCP). Ann Rheum Dis 63, 1090-1095

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Rheumatoid Factor

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EliA RF Detailer

Antigen

Rheumatoid factor (RF) is an antibody against the Fc portion of Immunoglobulin G (IgG), which is itself an antibody. RF and IgG join to form immune complexes which contribute to the disease process.

EliA Wells are coated with aggregated rabbit IgG.

Antibody prevalence and prognostic use

In combination with signs and symptoms, RF can play a role in both diagnosis and disease prognosis and, thus, constitutes one of the classification criteria proposed by the American College of Rheumatology (ACR). About 80% of people with rheumatoid arthritis have detectable rheumatoid factor. RF has been recognized as an important predictor of more severe disease. The prevalence of RA is markedly increased in individuals with RF antibodies of more than one isotype, most frequently, a combination of IgM and IgA.

Specificity

However, RF positivity shows low diagnostic specificity because RF are present in patients with other autoimmune and infectious diseases, and even in a noticeable proportion of normal healthy subjects, particularly in ageing individuals. RF can also be detected at high titers in most patients with primary Sjögren's syndrome and may also be elevated in chronic hepatitis, any chronic viral infection, leukemia, dermatomyositis, infectious mononucleosis, systemic sclerosis and systemic lupus erythematosus.

When is the measurement recommended?

Suspicion of Rheumatoid Arthritis and Sjögren's Syndrome.

Antibody isotypes

IgM and IgA

References

• De Angelis V, Meroni PL. Rheumatoid Factor. In: Autoantibodies, 2nd edition 2007, eds: Shoenfeld, Gershwin, Meroni. Elsevier, Amsterdam, pp 755-762
• Nishimura K, Sugiyama D, Kogota,Y et al. The battle between anti-cyclic citrullinated peptide and rheumatoid factor tests - a winner at last? Ann Intern Med 2007,146:797-808
• Jaskowski TD, Hill HR, Russo KL et al. Relationship Between Rheumatoid Factor Isotypes and IgG Anti-Cyclic Citrullinated Peptide Antibodies. J Rheumatol 2010 Jun 1; doi: 10.3899/jrheum.091236 [Epub ahead of print]

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