Anti CCP a diagnostic and Prognostic marker for Rheumatoid Arthritis
Khan S, Oyedotun L, Janjoa F,Maheshwaran S, Sheehy C
Rheumatology Department, University Hospital Waterford (UHW)
The main bio markers for Rheumatoid Arthritis are Rheumatoid factor ( RF), and Anti Cyclic Citrullinated Peptides ( CCP). They are used for diagnosis, as well as prognosis.
The presence and high titre of the two antibodies is associated with poor prognosis; smoking further increases the risk of adverse outcome, nearly 20 times more than in non smokers.
A retrospective Audit. 240 anti CCP levels were sent in 2014 207 patients had clinical letters available for evaluation. Parameters included were.
• Year of diagnosis
• Whether Anti CCP was checked at the time of diagnosis
• RF checked / not
• RF, positive or negative
• Anti CCP , positive or negative
• Anti CCP titre
• Rituximab treatment
• Smoking status
Anti CCP testing only became available in UHW in late 2013 and was restricted to rheumatology service only. These patients were diagnosed with inflammatory or Rheumatoid Arthritis between 1975 and 2014.
• 88.4% had RF checked, and 51 % were positive
• The titre for Anti CCP ranged from 01.12 _ >340.
• 6.6 % received Rituximab.
• 28% patients’ smoking status was recorded, 6.6 % were active smoker, 3.1 % ex smoker, and 20.4% non smokers.
• 29.9% of Anti CCP samples were positive.
• 50.2% of samples were sent at the time of initial presentation
• 3 RF negative patients were treated with RTX on the basis of anti CCP positivity
• 30 patients were Anti CCP positive, though they were RF negative
The availability of anti CCP testing added information regarding diagnosis, prognosis and management of patients with RA.