Systematic review: accuracy of anti-citrullinated peptide antibodies for diagnosing rheumatoid arthritis

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 x 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 x 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 second-generation anti-cyclic citrullinated peptide antibodies (anti-CCP2) in patients with early rheumatoid arthritis ( 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. Ann intern Med. 2010;152:456-464. www.annals.org For author affiliations, see end of text.