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Easy and Accurate Diagnosis of Rheumatoid Arthritis Using Anti-Cyclic Citrullinated Peptide 2 Antibody, Swollen Joint Count, and C-Reactive Protein/Rheumatoid Factor
TAKASHI YAMANE, AKIRA HASHIRAMOTO, YASUSHI TANAKA, KEN TSUMIYAMA, YASUSHI MIURA, KAZUKO SHIOZAWA, KAZUO CHIHARA, and SHUNICHI SHIOZAWA
ABSTRACT 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. (First Release Jan 15 2008; J Rheumatol 2008;35:414-20) Key Indexing Terms:
RHEUMATOID ARTHRITIS From the Department of Rheumatology, Kobe University Graduate School of Medicine; Rheumatic Diseases Division, Kobe University Hospital; Division of Endocrinology/Metabolism, Neurology, and Hematology/Oncology, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, Kobe; and Rheumatic Disease Centre, Konan Kakogawa Hospital, Kakogawa, Japan. T. Yamane, MD; A. Hashiramoto, MD, PhD; Y. Miura, MD, PhD; S. Shiozawa, MD, PhD, Investigator of the 21st Century Center of Excellence (COE), Japan, Department of Rheumatology, Kobe University Graduate School of Medicine and Rheumatic Diseases Division, Kobe University Hospital; K. Tsumiyama, MSc, Department of Rheumatology, Kobe University Graduate School of Medicine; Y. Tanaka, MD, PhD; K. Shiozawa, MD, PhD, Rheumatic Disease Centre, Konan Kakogawa Hospital; K. Chihara, MD, PhD, Division of Endocrinology/Metabolism, Neurology, and Hematology/Oncology, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine. Address reprint requests to Dr. S. Shiozawa, Department of Rheumatology, Kobe University Graduate School of Medicine, 7-10-2 Tomogaoka, Sumaku, Kobe 654-0142, Japan. E-mail: shioz@kobe-u.ac.jp Accepted for publication October 9, 2007. |
