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The Role of the Laboratory in the Diagnosis of Rheumatoid Arthritis

Development of Clinical Assays for Anti-Citrullinated Protein Antibodies

Slide 13

August 2011

There have been several generations of anti-CCP antibody assays.

The first generation assay used a cyclic peptide that had been derived from the human fillagrin protein. Although this assay had improved sensitivity over the initial indirect immunofluorescence assays, the sensitivity was still poor in comparison to rheumatoid factor. This type of assay was never widely used in most clinical laboratories.

The second generation anti-CCP antibody assay had significantly improved sensitivity, primarily because these assays used a panel of citrullinated peptides that had been identified through screening of peptide libraries using sera from patients with rheumatoid arthritis. The second generation assays are still widely used as a clinical test.

The third generation assays are relatively new, and use a synthetic form of a cyclic citrullinated peptide. The third generation assays are generally quite comparable to the second generation assays, although some studies have demonstrated a small improvement in sensitivity, primarily in patients with early disease.

Development of Clinical Assays


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