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Antibodies Against Citrullinated Peptides

A Role in the Diagnosis of Rheumatoid Arthritis


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Diagnostic Algorithm for CTDs

Slide 13

September 2008

Because of the similar sensitivity to Rheumatoid factor but the improved specificity, anti-CCP antibodies are the analyte of choice in helping to establish a diagnosis of Rheumatoid Arthritis. At Mayo Clinic, we offer this test individually as well as part of our connective tissue disease cascade. This cascade is designed to assist clinicians who are faced with a pt who appears to have systemic Rheumatic disease but in whom the clinical symptoms are not sufficient to narrow it down to a differential diagnoses.

When a test is ordered for a pt, two tests are done at the first level of testing: the anti-CCP antibody test and an ANA. A positive result for the anti-CCP antibody test is consistent with Rheumatoid Arthritis, although the result must be taken in the context of other lab results and the clinical picture of the pt. The other side of the cascade is more useful for other rheumatic diseases such as lupus and scleroderma. In the cascade, a positive ANA reflexes to the second level of testing. This second level of testing focuses on detection of discreet antibodies, that recognize specific antigens known to be associated with various connective tissue diseases. The pattern of discreet antibodies that are detected in conjunction with the anti-CCP antibody test can help the clinician narrow down the specific disease process that may be occurring in that particular patient. 

Diagnostic Algorithm for CTDs


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