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Cyclic Citrullinated Peptide Antibody

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Also known as: CCP Antibody; Citrulline Antibody; Anti-citrulline Antibody; Anti-cyclic Citrullinated Peptide; Anti-CCP; ACPA
Formal name: Cyclic Citrullinated Peptide Antibody

At a Glance

Why Get Tested?

To help diagnose rheumatoid arthritis (RA) and differentiate it from other types of arthritis; sometimes to help evaluate the prognosis of a person with RA

When to Get Tested?

When a doctor suspects RA in someone who has joint inflammation with symptoms that suggest but do not yet meet the criteria of RA

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

The Test Sample

What is being tested?

Cyclic citrullinated peptide antibodies are autoantibodies produced by the immune system that are directed against cyclic citrullinated peptides (CCP). Citrulline is naturally produced in the body as part of the metabolism of the amino acid arginine. However, in some proteins, the conversion of arginine to citrulline leads to production of structures that form a ring called cyclic citrullinated peptide. This alteration and the production of CCP antibodies often occur in people who have rheumatoid arthritis (RA). There is speculation that the formation of CCP may play a role in the autoimmune inflammatory process seen in the joints of those with RA. The CCP antibody test detects and measures CCP antibodies in the blood to help diagnose RA.

RA is a chronic, systemic autoimmune disease that causes inflammation, pain, stiffness, and destructive changes in the hands, feet, and other joints throughout the body. It can affect anyone at any age, but it usually develops between the ages of 40 and 60, and about 75% of those affected are women. The course of RA and its prognosis are variable. It may develop and progress slowly or rapidly. It may go into remission in some people and, in a few, it may go away. Left untreated, RA can shorten a person's lifespan and can, within a few years, leave many of those affected too disabled to work.

There are a variety of treatments available to minimize the complications of RA, but they depend on making an accurate diagnosis and on beginning treatment before the development of significant joint damage. Rheumatoid factor (RF) has been the primary blood test used to detect RA and distinguish it from other types of arthritis and other inflammatory processes. However, the sensitivity and specificity of RF are not ideal; it can be negative in people who have clinical signs of RA and positive in people who do not. Studies have shown that the CCP antibody test has a sensitivity and specificity that is equal to or better than RF and is more likely to be positive with early RA.

The 2010 Rheumatoid Arthritis Classification Criteria from the American College of Rheumatology (ACR) includes CCP antibody testing, along with RF, as part of its criteria for diagnosing rheumatoid arthritis. According to the ACR, CCP antibodies may be detected in about 50-60% of people with early RA, as early as 3-6 months after the beginning of symptoms. Early detection and diagnosis of RA allows doctors to begin aggressive treatment of the condition, minimizing the associated complications and tissue damage.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

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Aletaha, D. et. al. (2010 September). 2010 Rheumatoid Arthritis Classification Criteria, An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative Arthritis & Rheumatism Vol. 62, No. 9, September 2010, pp 2569–2581 [On-line information]. Available online at http://www.rheumatology.org/practice/clinical/classification/ra/2010_revised_criteria_classification_ra.pdf#search=%22CCP%22 through http://www.rheumatology.org. Accessed January 2012.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 76-77.

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(August 1, 2011) Center for Disease Control and Prevention. Rheumatoid Arthritis. Available online at http://www.cdc.gov/arthritis/basics/rheumatoid.htm through http://www.cdc.gov. Accessed February 2012.

(Updated December 2011) American College of Rheumatology. Rheumatoid Arthritis, Who gets rheumatoid arthritis? Available online at http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ra.asp through http://www.rheumatology.org. Accessed March 2012.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

Shiel, W. (2004 September 17, Reviewed). Citrulline Antibody. MedicineNet.com [On-line information]. Available online at http://www.medicinenet.com/citrulline_antibody/article.htm through http://www.medicinenet.com.

Check, W. (2003 June). Assay takes arthritis out of the gray zone. College of American Pathologists, Feature Story [On-line journal]. Available online at http://www.cap.org/apps/docs/cap_today/feature_stories/rheumarthritis_assay.html through http://www.cap.org.

Bizzarola, N. et. al. (2001). Diagnostic Accuracy of the Anti-Citrulline Antibody Assay for Rheumatoid Arthritis. Clinical Chemistry. 2001; 47:1089-1093. [On-line information]. Available online at http://www.clinchem.org/cgi/content/full/47/6/1089 through http://www.clinchem.org.

(2004 February 4, Updated). Cyclic Citrullinated Peptide (CCP): A New Serum Marker for Rheumatoid Arthritis. Foundation for Blood Research, Fact Sheet [On-line information]. Available online at http://www.fbr.org/publications/factsheets/fs-ccp.html through http://www.fbr.org.

Wiik, A., et. al. (2003). The Use of Anti-cyclic Citrullinated Peptide (anti-CCP) Antibodies in RA. American College of Rheumatology, Hotline [On-line article]. Available online at http://www.rheumatology.org/publications/hotline/1003anticcp.asp through http://www.rheumatology.org.

McCoy, T. (2003 October 24). Simple Blood Test May Predict The Development Of Rheumatoid Arthritis In Patients With Joint Pain. American College of Rheumatology, Arthritis News [On-line press release]. Available online at http://www.rheumatology.org/press/2003/pr1.asp through http://www.rheumatology.org.

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Douglas, D. (2004 September 21). Antibodies Predict Course of Early Arthritis. MedlinePlus Health Information from Reuters [On-line news, not available after 10/21/2004]. Available online at http://www.nlm.nih.gov/medlineplus/news/fullstory_20221.html through http://www.nlm.nih.gov.

Schellekens, G., et. al., (1998 January). Citrulline is an Essential Constituent of Antigenic Determinants Recognized by Rheumatoid Arthritis-specific Autoantibodies. J. Clin. Invest. Volume 101, Number 1, January 1998, 273-281 [On-line journal]. Available online at http://www.jci.org/cgi/content/abstract/101/1/273 through http://www.jci.org.

Dina Dadabhoy, M.D., University of Michigan, Division of Rheumatology.

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van der Helm-van Mil, A. et. al. (2005 June 30). Antibodies to Citrullinated Proteins and Differences in Clinical Progression of Rheumatoid Arthritis. Medscape from Arthritis Res Ther. 2005;7(5):R949-R958 [On-line information]. Available online at http://www.medscape.com/viewarticle/507248 through http://www.medscape.com. Accessed on 8-26-08.

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(© 2003). The Use of Anti-cyclic Citrullinated Peptide (anti-CCP) Antibodies in RA. American College of Rheumatology [On-line information]. Available online at http://www.rheumatology.org/publications/hotline/1003anticcp.asp through http://www.rheumatology.org. Accessed on 8/26/08.

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