Anti-CCP antibody and RA

-Tokyo Arthritis Clinic-

What are the important anti-CCP antibodies in RA diagnosis?

Anti-CCP antibody is the most important blood test for diagnosing and treating RA.

Official name
Anti-cyclic citrullinated peptide antibody
Abbreviated name
Anti-CCP antibody
English name
Anti-cyclic citrullinated peptide antibody=ACPA

First, the normal value (unit) is less than 4.5 (U / mL).

This is a number that is common to most inspection agencies used in Japan.

(The standard value may differ when examined overseas)

Rheumatoid arthritis develops within a few years
if anti-CCP antibody is positive

If anti-CCP antibody is positive

Patients who develop rheumatoid arthritis have been found to be anti-CCP antibody positive long before the onset.

It is known that if an anti-CCP antibody happens to be positive in a human dock, rheumatoid arthritis will develop within a few years (a few months to 5 years) with a probability of 80% or more.Since it becomes positive from the stage where there are almost no symptoms, it can be used to predict the onset of rheumatoid arthritis. For example, if you are worried about heredity, such as when your mother or siblings have multiple patients with rheumatoid arthritis, you may want to check it once.

Know if your anti-CCP antibody is positive

First, there are three important blood tests for diagnosing RA: CRP, RF (rheumatoid factor), and anti-CCP antibody.

The video introduces the content of anti-CCP antibody, which is one of the important blood tests, explained to patients in daily medical examinations along with how to catch the disease called RA.

Anti-CCP antibody count and RA severity

The number of anti-CCP antibodies is not clearly directly proportional to the severity of RA.

For example, among the patients at our hospital, some of them have more than 1,000 anti-CCP antibodies.

Some people have a maximum of 5,000 units.

For example, if the anti-CCP antibody is 500, it is not 10 times worse than 50 people.

However, roughly speaking, the height of the numbers and the momentum of the disease of RA are roughly proportional (rather than the severity).

Comparing the average of those who are positive with anti-CCP antibody around 4.5 to 50 and those who are 100 or more, there is no doubt that the group with 100 or more has stronger RA.

In addition, those with high numbers tend to have long-term treatment (units of 5 to 10 years or more).

At our hospital, we will consider whether the drug can be reduced when RA enters a stable period and becomes almost in a state of remission. At that timing, anti-CCP antibody is measured and used as a judgment material. (About once every 1-3 years)

If the value is significantly lower than the value at the start of treatment, it may be possible to reduce the dose of the drug, and if it is not so low, the drug should be reduced carefully.

About RA

Anti-CCP antibody positive is called "genuine RA", and anti-CCP antibody negative is called "halfway RA" or rheumatoid constitution.

"Half-finished RA" has little progress of deformation even if there is pain.

On the other hand, in the case of RF-positive and anti-CCP antibody-positive rheumatoid factor, the deformation often progresses in a short period of time unless the joint swelling is removed as soon as possible by treating the first move and the first move.

Current treatments for RA cannot change the underlying cause, the predisposition to RA and the genes.

Even if the treatment is successful and the pain disappears, those who are positive for anti-CCP antibody are usually positive for a long period of time, 10 to 20 years or more as a guide.

Therefore, even if you bring it into a state of remission, symptoms often appear if you gradually reduce the amount of medicine.

In that sense, genuine RA who is positive for anti-CCP antibody must be prepared to go to the hospital and take the medication for a long period of 10 to 20 years.

It has also been found that if anti-CCP antibody-positive people develop rheumatoid arthritis, joint deformity is more likely to progress within 1-3 years without adequate early treatment . Evidence literature # 1 # 2

Joint destruction (bone destruction) due to rheumatoid arthritis was previously thought to progress smoothly as shown in the graph above, but in reality it has been found that it progresses rapidly in the first two years.

Therefore, for those with high anti-CCP antibody, it is important to take the initiative and take the initiative in treatment.

Anti-CCP antibody positive and RA treatment

Will the value of anti-CCP antibody decrease?

It seems that the number of anti-CCP antibodies often goes down as the drug works and RA improves.

However, since the anti-CCP antibody expresses the part that is very close to the root of the onset of RA, it is not necessarily proportional to the symptoms that appear on the actual surface, and even if it improves, the number will continue to rise. You can also see the case. Therefore, it is not always useful for determining the therapeutic effect of RA. Blood tests for anti-CCP antibodies are only allowed to be measured for the purpose of determining biopharmacy changes in medical insurance after RA diagnosis.

Asymptomatic

Even if the anti-CCP antibody is positive, we do not treat patients who are completely asymptomatic.

There is a globally used classification standard for RA (ACR / EULAR2010 standard).

It seems that most specialists start treatment with this as a guide. It's a very well-thought-out standard, so it's never too late to meet this standard and start treatment immediately.

However, even if CRP is normal, synovitis lesions of the cervical spine and early inflammatory findings that can only be found by ultrasound or MRI are often found.

Careful scrutiny and evaluation of whether RA has really begun is important to ensure that the right time to start treatment is not missed . In addition, even if treatment is started, joint destruction often progresses if inflammation continues with the drug being inadequately effective.

Reference citation

Is Rheumatoid Arthritis Relief Possible? -Ferdinand C. Breedveld APLAR 2010

Evidence literature

#1 Berglin E,Johansson T,Sundin U,et al:Radiological outcome in rheumatoid arthritis is predicted by presence of antibodiesagainst cyclic citrullinated peptide before and at disease onset,and by IgA-RF at disease onset.―

http://ard.bmj.com/content/65/4/453.short

#2 Syverrsen SW,Gaarder PI,Gokk GL,et al:High anti-CCP levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: results from a 10-year longitudinal study―

http://ard.bmj.com/content/early/2007/05/25/ard.2006.068247.abstract

Alessandri C,Bombardieri M,Papa N,et al:Decrease of anti-cyclic citrullinated peptide antibodies and rheumatoid factor following anti-TNFα therapy (infliximab) in rheumatoid arthritis is associated with clinical improvement―

http://ard.bmj.com/content/63/10/1218.abstract

Caramaschi P,Biasi D,Tonolli E,et al:Antibodies against cyclic citrullinated peptides in patients affected by rheumatoid arthritis before and after infliximab treatment―

https://www.ncbi.nlm.nih.gov/pubmed/15726373

De Rycke L,Verthlst X,Kruithof E,et al:Rheumatoid factor, but not anti-cyclic citrullinated peptide antibodies, is modulated by infliximab treatment in rheumatoid arthritis―

http://ard.bmj.com/content/64/2/299.abstract

van Dongen H et al.Arthritis Rheum 2007;56(5): 1424-1432 Efficacy of Methotrexate Treatment in Patients With ProbableRheumatoid Arthritis

http://onlinelibrary.wiley.com/doi/10.1002/art.22525/pdf

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