TY - JOUR
T1 - Easy and accurate diagnosis of rheumatoid arthritis using anti-cyclic citrullinated peptide 2 antibody, swollen joint count, and C-reactive protein/rheumatoid factor
AU - Yamane, Takashi
AU - Hashiramoto, Akira
AU - Tanaka, Yasushi
AU - Tsumiyama, Ken
AU - Miura, Yasushi
AU - Shiozawa, Kazuko
AU - Chihara, Kazuo
AU - Shiozawa, Shunichi
PY - 2008/3
Y1 - 2008/3
N2 - Objective. To determine an easy-to-use diagnostic criterion for early rheumatoid arthritis (RA) that may be useful for general physicians, using anti-cyclic citrullinated peptide (CCP) antibody. Methods. We prospectively studied 435 patients who first visited the hospital with arthritic symptoms within 24 months, including 264 visitors within 6 months. The diagnosis was made on their first visit by examination and laboratory tests including anti-CCP antibodies, rheumatoid factor (RF) and C-reactive protein (CRP), and radiograph. Results. The diagnostic specificity and positive predictive value (PPV) of anti-CCP2 assay were 94.9% and 87.8%, respectively, and those of anti-CCP2 plus RF were 96.9% and 90.9% for the patients who first visited having morning stiffness, arthralgia, and/or joint swelling within 3 months from onset (n = 165). For the patients who first visited later, but within 24 months from onset (n = 260), the diagnostic specificity and PPV were extremely high, 98.7% and 95.5%, when anti-CCP2 assay was coevaluated with RF, CRP, and more than 3 swollen joints. Respective combinations of anti-CCP2 assay plus either 2 of 3 measures were also highly specific. Conclusion. A diagnostic criterion including anti-CCP2 assay in combination with RF, CRP, and/or swollen joints is less sensitive but highly specific, and accurately predicts future development of RA among those with arthritic symptoms who first consulted doctors within 2 years after onset. It should be highly useful for the general physician without special techniques or devices.
AB - Objective. To determine an easy-to-use diagnostic criterion for early rheumatoid arthritis (RA) that may be useful for general physicians, using anti-cyclic citrullinated peptide (CCP) antibody. Methods. We prospectively studied 435 patients who first visited the hospital with arthritic symptoms within 24 months, including 264 visitors within 6 months. The diagnosis was made on their first visit by examination and laboratory tests including anti-CCP antibodies, rheumatoid factor (RF) and C-reactive protein (CRP), and radiograph. Results. The diagnostic specificity and positive predictive value (PPV) of anti-CCP2 assay were 94.9% and 87.8%, respectively, and those of anti-CCP2 plus RF were 96.9% and 90.9% for the patients who first visited having morning stiffness, arthralgia, and/or joint swelling within 3 months from onset (n = 165). For the patients who first visited later, but within 24 months from onset (n = 260), the diagnostic specificity and PPV were extremely high, 98.7% and 95.5%, when anti-CCP2 assay was coevaluated with RF, CRP, and more than 3 swollen joints. Respective combinations of anti-CCP2 assay plus either 2 of 3 measures were also highly specific. Conclusion. A diagnostic criterion including anti-CCP2 assay in combination with RF, CRP, and/or swollen joints is less sensitive but highly specific, and accurately predicts future development of RA among those with arthritic symptoms who first consulted doctors within 2 years after onset. It should be highly useful for the general physician without special techniques or devices.
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M3 - Article
C2 - 18203327
AN - SCOPUS:40649106050
VL - 35
SP - 414
EP - 420
JO - Journal of Rheumatology
JF - Journal of Rheumatology
SN - 0315-162X
IS - 3
ER -