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BMJ 2010; 340 doi: (Published 12 April 2010) Cite this as: BMJ 2010;340:c1968

Newer anticitrullinated peptide antibody assays seem best for early detection of rheumatoid arthritis

Early treatment of rheumatoid arthritis has been shown to reduce sequelae such as joint damage and disability, as well as to prolong life, but early diagnosis remains a challenge. In addition to testing for rheumatoid factor, many doctors are adopting the use of assays for detecting anticitrullinated peptide antibodies, which are thought to be as sensitive but more specific than tests for rheumatoid factor. A systematic review of 151 observational studies confirms this.

The sensitivity of these assays in individual studies ranged from 12% to 93%, whereas specificity ranged from 63% to 100%. The pooled analysis set sensitivity at 67% and specificity at 96%. The figure shows the 95% prediction region, where the results of 95% of future studies are expected to lie.

Second generation anticitrullinated peptide antibody assays have better diagnostic accuracy than all other tests. In 15 cohort studies of early rheumatoid arthritis, second generation tests helped diagnose early rheumatoid arthritis, which can lead to early treatment, although a negative test result does not rule out the disease …

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