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Triple positivity for anti–citrullinated protein autoantibodies, rheumatoid factor, and anti–carbamylated protein antibodies conferring high specificity for rheumatoid arthritis: implications for very early identification of at‐risk individuals
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2018 (English)In: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 70, no 11, p. 1721-1731Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: In rheumatoid arthritis(RA), the autoantibodies anti-citrullinated protein antibodies(ACPA) and rheumatoid factor(RF) are commonly used to aid RA diagnosis. Although these autoantibodies are mainly found in RA, their specificity is not optimal. It is therefore difficult to identify RA patients, especially in very early disease, based on the presence of ACPA and RF alone. Also, anti-carbamylated protein(anti-CarP) antibodies have diagnostic and prognostic value as the presence of anti-CarP antibodies associates with joint damage in RA patients and with future RA development in arthralgia patients. Therefore, we aimed to investigate the value of combined antibody testing in relation to prediction and diagnosis of (early) RA.

METHODS: A literature search resulted in twelve studies, consisting of RA patients, pre-RA individuals, disease controls, healthy first-degree relatives of RA patients or healthy controls, in which data on RF, ACPA and anti-CarP antibody-status was available. Random effects meta-analyses were carried out for several antibody combinations.

RESULTS: The individual antibodies are highly prevalent in RA(34%-80%) compared to the control groups, but are also present in non-RA controls(0%-23%). To classify most people correctly as RA or non-RA, the combination of ACPA and/or RF often performs well(specificity:65-100, sensitivity:59-88). However, triple positivity for ACPA, RF and anti-CarP antibodies results in a higher specificity(98-100) (accompanied by a lower sensitivity(11-39)).

CONCLUSIONS: As the rheumatology field is moving towards very early identification of RA and possible screening for individuals at maximum risk in populations with a low pre-test probability, triple positivity provides interesting information on individuals at risk to develop RA.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018. Vol. 70, no 11, p. 1721-1731
Keywords [en]
Rheumatoid arthritis, anti-carbamylated protein antibodies, anti-citrullinated protein antibodies, autoantibodies, rheumatoid factor
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:umu:diva-150999DOI: 10.1002/art.40562ISI: 000448797600004PubMedID: 29781231OAI: oai:DiVA.org:umu-150999DiVA, id: diva2:1240812
Available from: 2018-08-22 Created: 2018-08-22 Last updated: 2018-11-30Bibliographically approved

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Brink, MikaelRantapää-Dahlqvist, Solbritt

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