Biological Significance of Anti–Cyclic Citrullinated Peptide Antibody in Rheumatoid Arthritis
Authors: Ronenn Roubenoff, Evan Beckman, Michael Weinblatt, Nancy Shadick, Peter K. Gregersen
Journal: Annals of Internal Medicine (2008)

Letters4 March 2008Biological Significance of Anti–Cyclic Citrullinated Peptide Antibody in Rheumatoid ArthritisRonenn Roubenoff, MD, MHS, Evan Beckman, MD, Michael Weinblatt, MD, Nancy Shadick, MD, MPH, and Peter K. Gregersen, MDRonenn Roubenoff, MD, MHSFrom Biogen Idec Immunology Research & Development, Cambridge, MA 02142; Brigham & Women's Hospital, Boston, MA 02115; and Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY 11030.Search for more papers by this author, Evan Beckman, MDFrom Biogen Idec Immunology Research & Development, Cambridge, MA 02142; Brigham & Women's Hospital, Boston, MA 02115; and Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY 11030.Search for more papers by this author, Michael Weinblatt, MDFrom Biogen Idec Immunology Research & Development, Cambridge, MA 02142; Brigham & Women's Hospital, Boston, MA 02115; and Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY 11030.Search for more papers by this author, Nancy Shadick, MD, MPHFrom Biogen Idec Immunology Research & Development, Cambridge, MA 02142; Brigham & Women's Hospital, Boston, MA 02115; and Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY 11030.Search for more papers by this author, and Peter K. Gregersen, MDFrom Biogen Idec Immunology Research & Development, Cambridge, MA 02142; Brigham & Women's Hospital, Boston, MA 02115; and Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY 11030.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-5-200803040-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read with great interest the thorough meta-analysis and review by Nishimura and colleagues (1) on the diagnostic accuracy of anti–cyclic citrullinated peptide (CCP) antibody in rheumatoid arthritis (RA). The authors conclude that although anti-CCP antibodies are more specific than rheumatoid factor, their sensitivity is only 67%. However, we believe that anti-CCP may in fact define a biologically distinct subset of RA, and therefore a simple assessment of its sensitivity for RA in general may be misleading. Emerging data show that the presence of anti-CCP antibodies interacts with genetic risk factors, such as the shared epitope in ...References1. Nishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakazawa T, Kawano S, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med. 2007;146:797-808. [PMID: 17548411] LinkGoogle Scholar2. Irigoyen P, Lee AT, Wener MH, Li W, Kern M, Batliwalla F, et al. Regulation of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis: contrasting effects of HLA-DR3 and the shared epitope alleles. Arthritis Rheum. 2005;52:3813-8. [PMID: 16320316] CrossrefMedlineGoogle Scholar3. Pedersen M, Jacobsen S, Garred P, Madsen HO, Klarlund M, Svejgaard A, et al. Strong combined gene-environment effects in anti-cyclic citrullinated peptide-positive rheumatoid arthritis: a nationwide case–control study in Denmark. Arthritis Rheum. 2007;56:1446-53. [PMID: 17469102] CrossrefMedlineGoogle Scholar4. Lee HS, Irigoyen P, Kern M, Lee A, Batliwalla F, Khalili H, et al. Interaction between smoking, the shared epitope, and anti-cyclic citrullinated peptide: a mixed picture in three large North American rheumatoid arthritis cohorts. Arthritis Rheum. 2007;56:1745-53. [PMID: 17530703] CrossrefMedlineGoogle Scholar5. Mikuls TR, O'Dell JR, Stoner JA, Parrish LA, Arend WP, Norris JM, et al. Association of rheumatoid arthritis treatment response and disease duration with declines in serum levels of IgM rheumatoid factor and anti-cyclic citrullinated peptide antibody. Arthritis Rheum. 2004;50:3776-82. [PMID: 15593224] CrossrefMedlineGoogle Scholar6. Rosenwald A, Wright G, Chan WC, Connors JM, Campo E, Fisher RI, et al; Lymphoma/Leukemia Molecular Profiling Project. The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:1937-47. [PMID: 12075054] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Biogen Idec Immunology Research & Development, Cambridge, MA 02142; Brigham & Women's Hospital, Boston, MA 02115; and Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY 11030.Disclosures: Drs. Roubenoff and Beckman are employees of Biogen Idec. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-analysis: Diagnostic Accuracy of Anti–Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor for Rheumatoid Arthritis Kunihiro Nishimura , Daisuke Sugiyama , Yoshinori Kogata , Goh Tsuji , Takashi Nakazawa , Seiji Kawano , Katsuyasu Saigo , Akio Morinobu , Masahiro Koshiba , Karen M. Kuntz , Isao Kamae , and Shunichi Kumagai Biological Significance of Anti–Cyclic Citrullinated Peptide Antibody in Rheumatoid Arthritis Daniel G. Arkfeld Biological Significance of Anti–Cyclic Citrullinated Peptide Antibody in Rheumatoid Arthritis Kunihiro Nishimura , Akio Morinobu , and Shunichi Kumagai Metrics Cited ByComparative Utility of Anti-Citrullinated Protein Antibodies Verses Rheumatoid Factor in the Management of Rheumatoid Arthritis 4 March 2008Volume 148, Issue 5Page: 403KeywordsAntibody productionConflicts of interestForecastingGeneticsHistologyLymphomaMedical risk factorsRheumatoid arthritisSpecificity ePublished: 4 March 2008 Issue Published: 4 March 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...