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The diagnostic significance of autoantibodies in patients with very early rheumatoid arthritis

In the past few years, several novel autoantibodies (autoAbs) have been described in patients with rheumatoid arthritis (RA), including an autoAb to citrullinated antigens (anti-CCP) and anti-RA33 autoAb. It was our aim to assess the value of these two autoAbs in relation to rheumatoid factor (RF) in discriminating RA from non-RA in a cohort of patients with very early arthritis.

Ninety-four patients with arthritis of less than 3 months' duration were included in this prospective study. Follow-up was for at least 1 year. Sixty-one patients had a final diagnosis of RA and 33 had other arthritides. Among the RA patients, RF was present in 34 (56%), anti-CCP in 18 (30%), and anti-RA33 in 15 (25%) at their first visit. Among the 33 non-RA patients, 6 were RF-positive, 3 had anti-RA33, and 1 had anti-CCP. Thus, anti-CCP was very specific for RA with a positive predictive value (PPV) of 95%, while RF and anti-RA33 were somewhat less specific, with PPVs of 85% and 83%, respectively. However, the co-occurrence of anti-RA33 and RF was observed exclusively in RA patients and thus had a PPV of 100% in this relatively small cohort of patients. In conclusion, these data suggest that the determination of autoantibodies such as anti-CCP and anti-A2/RA33 in addition to RF may be quite helpful in the early diagnosis of RA.

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Nell, V., Machold, K., Hueber, W. et al. The diagnostic significance of autoantibodies in patients with very early rheumatoid arthritis. Arthritis Res Ther 5 (Suppl 1), 16 (2003).

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