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Review: anti–cyclic citrullinated peptide antibody is a more specific test for rheumatoid arthritis than rheumatoid factor

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Are rheumatoid factor (RF) and anti–cyclic citrullinated peptide antibody (anti-CCP) accurate tests for rheumatoid arthritis (RA)?

Nishimura K, Sugiyama D, Kogata Y, 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.

Clinical impact ratings Rheumatology ★★★★★★★ Internal medicine ★★★★★★⋆


Embedded ImageData sources:

Medline (to September 2006) and reference lists.

Embedded ImageStudy selection and assessment:

studies published after 1987 that evaluated the accuracy of RF or anti-CCP for diagnosis of RA in ⩾10 participants. 50 studies of RF (n = 15 286, median age 53 y, 68% women) and 37 studies of anti-CCP (n = 14 949, median age 57 y, 59% women) met the selection criteria.

Embedded ImageOutcomes:

pooled sensitivity, specificity, and positive and negative likelihood ratios (LRs). The reference standard for RA was the 1987 revised American College of Rheumatology criteria.


Anti-CCP and IgM RF had similar …

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  • Sources of funding: Ministry of Education, Culture, Sports, Science, and Technology, Japan and Ministry of Health, Labour, and Welfare, Japan.