Blood draw
Anti‑CCP (Rheumatoid Arthritis)
Anti-CCP antibodies for support of early diagnosis of rheumatoid arthritis.
€ 41,00
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Inflammation and immunity · Blood
Anti-CCP
Antibodies that are fairly specific for rheumatoid arthritis; support the diagnosis when joints are inflamed.
At a glance
- Measured in blood
- In 1 test panel
- No special preparation
Explanation
Anti-CCP: what is measured?
Anti-CCP are autoantibodies against proteins to which the body has attached the substance citrulline (cyclic citrullinated peptides). These antibodies mainly go with rheumatoid arthritis (RA), a chronic inflammation of joints caused by the body's own immune system. The test measures how many of these antibodies are in the blood; the higher the value, the greater the chance of RA. The antibodies can be present years before the first symptoms.
What can it detect?
- Rheumatoid arthritis (RA), including at an early stage
- An increased chance of developing joint inflammation in someone who already has joint symptoms
Result
What does the result mean?
Anti-CCP too high
A raised anti-CCP fits rheumatoid arthritis if there is also joint inflammation: painful, swollen or warm joints, usually on both sides of the body, with stiffness that is worst in the morning. The higher the value, the greater the chance of RA. Without joint inflammation, a raised value is not a diagnosis: up to 5 in 100 healthy people have rheumatoid factor and/or anti-CCP without RA. In people who do have RA, a positive anti-CCP is linked to a less favorable course, such as a greater chance of joint damage.
Anti-CCP too low
A value below the laboratory's cut-off is the normal result. A negative anti-CCP does not rule out rheumatoid arthritis: in about half of people with early RA, the test is negative. In that case, rheumatoid factor may still be positive. Whether there is RA is judged by a doctor mainly from the joints themselves, together with the symptoms and inflammation markers.
After an abnormal result
With inflamed joints, the GP usually refers you promptly to a rheumatologist, even if anti-CCP is negative, because early treatment limits joint damage. The rheumatologist assesses the result together with the physical examination, the inflammation markers and sometimes imaging. With a raised value without joint inflammation, no treatment follows.
Reliability
How reliable is the test?
According to the Dutch Society for Clinical Chemistry (NVKC), anti-CCP is about as sensitive as rheumatoid factor, but much more specific for rheumatoid arthritis. The Dutch guideline on rheumatoid arthritis advises measuring anti-CCP and rheumatoid factor together when RA is suspected, with anti-CCP being the better predictor of the diagnosis. The NVKC advises against doing the test when the chance of RA is small, certainly not if there is no joint inflammation: screening people without joint symptoms mainly produces false-positive results. The test should not be used to monitor disease activity.
What can affect the result?
- Up to 5 in 100 healthy people have rheumatoid factor and/or anti-CCP without rheumatoid arthritis.
- About half of people with early RA have no detectable anti-CCP.
- Test methods and cut-off values differ per laboratory; values from different labs cannot simply be compared.
- The level of the value says little about how active the disease is during treatment.
Who it is for
Who is the test useful for?
Useful for
Useful with joints that are swollen, warm or painful and stiff in the morning, especially in the hands, wrists or feet, when a doctor is considering rheumatoid arthritis. According to the Dutch Society for Clinical Chemistry (NVKC), the test is pointless in people without joint symptoms: there is no treatment that prevents RA, and a positive result is then usually false-positive. With joint pain without signs of inflammation, the yield is also small.
How common is it?
Rheumatoid arthritis occurs in about 0.5 to 1 in 100 people. Each year, about 3 in 10,000 people are diagnosed. RA occurs at all ages and more often in women than in men.
NVKC Sensible Diagnostics and the FMS guideline on rheumatoid arthritis (NVR)
Drawbacks and risks
- A raised anti-CCP without joint inflammation can cause long-lasting worry, while there is no treatment that prevents rheumatoid arthritis.
- A negative result can give false reassurance while the joints are in fact inflamed.
Get tested
Anti-CCP: test panels
Anti-CCP is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and resultsMore explanations
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