The Diagnostic Significance And Predictive Value Of Articular Erosion Of Anti-Cyclic Citrullinated Peptide Antibody In Patients With Rheumatoid Arthritis

OBJECTIVE We explored the diagnostic significance of anti-cyclic citrullinated peptide(CCP) antibody(anti-CCP) and the role it plays in the articular erosion in patients with rheumatoid arthritis(RA). Furthermore, We evaluate several risk factors comprehensively combining with other laboratory and clinical markers.METHOD We evaluated the diagnostic significance of anti-CCP, AKA and RF using ELISA, IIF and rate nephelometry respectively.75 RA patients were devided into 2 groups(none or limited radiographic damege group(group 1) and severe radiographic damage group (group 2) ) based on Larsen's score system. We investigated the distribution of anti-CCP, AKA and RF in patients of the two groups. A univariate analysis was used to determine whether anti-CCP, AKA, RF, ANA, ESR, CRP or cutaneous nodules plays a role on articular erosion in RA. To determine which had the best predictive value for severe radiographic damage, all variables were entered into a logistic regression model. RESULT 1) The sensitivity and specificity of Anti-CCP, AKA and RF were49%,94% ; 50%,93% ; 79%,67% respectively. When assayed together, these parameters would be changed if both markers were positive(anti-CCP and AKA, anti-CCP and RF, AKA and RF). 2) The positive rate of these three markers were much higher in group 2 than that in group 1. 3) Among these three markers, anti-CCP had the highest positive predictive value(0.68) and OR(6.71) for articular erosion in RA. 4) Logistic regression analysis showed a strong correlation between anti-CCP , AKA, CRP or cutaneous nodules and less favourable disease outcomes. Anti-CCP had the strongest correlation with severe radiographic damage.CONCLUSION 1) Anti-CCP is a satisfactory marker for RA and can be used in clinical practice extensively. 2) Diagnostic accuracy would be raised when anti-CCP combined with AKA and RF. 3) Anti-CCP has a strong correlation with severe radiographic damage. 4) To investigate multiple risk factors of articular erosion will be helpful to pridict the outcome of RA.