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Systematic Review: Accuracy of Anti--Citrullinated Peptide Antibodies for Diagnosing Rheumatoid Arthritis.
- Source :
-
Annals of Internal Medicine . 4/6/2010, Vol. 152 Issue 7, p456-W.166. 21p. 1 Diagram, 4 Charts, 2 Graphs. - Publication Year :
- 2010
-
Abstract
- Background: Early recognition and treatment of rheumatoid arthritis is important to prevent irreversible joint damage. Anti-citrullinated peptide antibodies (ACPA) have been suggested for early diagnosis. Purpose: To compare the accuracy of ACPA and rheumatoid factor in diagnosing rheumatoid arthritis in patients with early symptoms of the disease. Data Sources: 10 medical databases from inception to September 2009, with no language or publication restrictions, and references of included studies. Study Selection: Two independent reviewers screened searches. Full articles were assessed by one reviewer and checked by a second reviewer to identify studies that reported 2 × 2 data on ACPA for the diagnosis of rheumatoid arthritis (by 1987 American College of Rheumatology criteria). Data Extraction: One reviewer abstracted data on patient characteristics, ACPA details, and 2 × 2 data and assessed study quality by using the QUADAS tool. A second reviewer checked extractions. Data Synthesis: 151 studies were included, with considerable heterogeneity in sensitivity (range, 12% to 93%) and specificity (range, 63% to 100%). In cohort studies that investigated secondgeneration anti-cyclic citrullinated peptide antibodies (anti-CCP2) in patients with early rheumatoid arthritis (<2 years), summary sensitivity and specificity were 57% (95% CI, 51% to 63%) and 96% (CI, 93% to 97%), respectively. Case-control and cross-sectional studies and studies of patients with established rheumatoid arthritis all overestimated sensitivity. Anti-CCP2 had greater specificity than rheumatoid factor (96% vs. 86%), with similar sensitivity. Evidence was insufficient to ascertain whether the combination of anti-CCP2 and rheumatoid factor provides additional benefit over anti-CCP2 alone. Limitations: Most studies used a diagnostic case-control design, which overestimated sensitivity. Items relating to study quality were rarely reported. Publication bias could not be assessed. Conclusion: Anti-CCP2 should be included in the work-up of patients with early symptoms of rheumatoid arthritis. Primary Funding Source: United Kingdom Medical Research Council. [ABSTRACT FROM AUTHOR]
- Subjects :
- *PEPTIDES
*IMMUNOGLOBULINS
*RHEUMATOID arthritis
*JOINT diseases
*MEDICAL research
Subjects
Details
- Language :
- English
- ISSN :
- 00034819
- Volume :
- 152
- Issue :
- 7
- Database :
- Academic Search Index
- Journal :
- Annals of Internal Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 49038952
- Full Text :
- https://doi.org/10.7326/0003-4819-152-7-201004060-00010