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Int J Rheum Dis. 2016 Sep;19(9):880-6. doi: 10.1111/1756-185X.12552. Epub 2015 May 4.

Diagnostic performance of anti-cyclic citrullinated peptide and rheumatoid factor in patients with rheumatoid arthritis.

Chang PY1,2,3, Yang CT4, Cheng CH1,2, Yu KH5,6.

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Department of Laboratory Medicine, Chang-Gung Memorial Hospital, Tao-Yuan, Taiwan.
Department of Medical Biotechnology and Laboratory Science, Tao-Yuan, Taiwan.
Chang Gung University, Tao-Yuan, Taiwan.
Division of Chinese Medicine, Chang-Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan.
Chang Gung University, Tao-Yuan, Taiwan.
Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang-Gung University, Tao-Yuan, Taiwan.



To compare the diagnostic performance of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) in the diagnosis of patients with rheumatoid arthritis (RA) in Taiwan.


Serum concentrations of RF and anti-CCP were measured in 246 cases, including 39 patients with RA and 207 patients with other rheumatic diseases (non-RA). The age, sex, clinical presentation, RF, anti-CCP results and the final diagnoses were recorded and analyzed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated.


Among all 246 patients, 39 (15.9%) were diagnosed with RA and 207 (84.1%) were diagnosed with other rheumatic diseases (non-RA). In the diagnosis of RA, the sensitivity, specificity, PPV, NPV, LR+ and LR- of the RF test were 67%, 79%, 37%, 93%, 3.12, and 0.42, respectively. The corresponding data for the anti-CCP test were 79%, 98%, 86%, 96%, 32.91 and 0.21, respectively. The presence of either anti-CCP or RF increased the sensitivity to 85%, and when they both were present, the specificity increased to 98%. Among the 39 RA patients, 26 (66.7%) tested positive for RF, and 31 (79.5%) tested positive for anti-CCP. RF was positive in two of eight anti-CCP-negative patients with RA, and anti-CCP was positive in seven of 13 RF-negative patients with RA.


The RF and anti-CCP tests are complementary, and the co-detection of these antibodies can increase the detection rate and provide important clinical value in the diagnosis of RA. Both anti-CCP and RF positivity are useful for the diagnosis of RA, and use of both tests together improves the diagnostic sensitivity.


anti-cyclic citrullinated peptide; likelihood ratio; predictive value; rheumatoid arthritis; rheumatoid factor; sensitivity

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