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A cyclic citrullinated peptide (CCP) antibody test is primarily ordered along with an RF test when someone has signs and symptoms that may be due to previously undiagnosed inflammatory arthritis or has been diagnosed with undifferentiated arthritis. It may be ordered as a follow-up test to a negative RF test when clinical signs and symptoms lead the doctor to suspect RA.

Test at a glance

Clinical Utility
​A cyclic citrullinated peptide (CCP) antibody test may be ordered along with or following a rheumatoid factor (RF) test to help diagnose rheumatoid arthritis (RA) and to assess the severity and probable course of the disease (prognosis). CCP antibody may also be ordered to help evaluate patients at high risk of developing RA.

Ordering
​On the requisition form, enter ‘Anti-CCP’, in the ‘Other Tests’ section. 

Patient instructions
​A simple blood sample is required and can be collected at any LifeLabs Patient Service Centre.
Turnaround Time
​Test results will be available within 1 day.

Cost
​This test is not currently covered by provincial health insurance plans, but may be covered by your extended health insurance plan. Contact us to find out about the current fee for the test.

BC – This test is covered by MSP if ordered by a Rheumatologist or Internal Medicine Specialist.

Cautions
​No test preparations are needed.

Healthcare Professional Information

​What is being tested?

Cyclic citrullinated peptide (CCP) antibodies are autoantibodies (IgG) that are directed against citrullinated residues on various, usually structural, proteins. Citrulline is naturally produced in the body as part of the metabolism of arginine during apoptosis and necrosis, causing structural changes to the protein and consequent degradation. However,  in most cases, the proteins, which have been citrullinated, are not extensively exposed to the immune system. The production and subsequent release of these citrullinated proteins often occur in the synovium of people who have rheumatoid arthritis (RA) due to the excessive inflammatory process.  These citrullinated proteins, in combination with the RA specific MHC II alleles, cause the immune system of certain individuals to develop antibodies to CCP. There is speculation that the formation of CCP may play a role in the autoimmune inflammatory process seen in the joints of those with RA. The CCP antibody test detects and measures CCP antibodies in the blood to help diagnose RA.RA is a chronic, systemic autoimmune disease that causes inflammation, pain, stiffness, and destructive changes in the hands, feet, and other joints throughout the body. It can affect anyone at any age, but it usually develops between the ages of 40 and 60, and about 75% of those affected are women. The course of RA and its prognosis are variable. It may develop and progress slowly or rapidly. It may go into remission in some people and, in a few, it may go away. Left untreated, RA can shorten a person's lifespan and can, within a few years, leave many of those affected too disabled to work.

There are a variety of treatments available to minimize the complications of RA, but they depend on making an accurate diagnosis and on beginning treatment before the development of significant joint damage. Rheumatoid factor (RF) has been the primary blood test used to detect RA and distinguish it from other types of arthritis and other inflammatory processes. However, the sensitivity and specificity of RF are not ideal; it can be negative in people who have clinical signs of RA and positive in people who do not. Though CCP antibodies show no increase in sensitivity over RF (60-80%), CCP antibodies are detectable earlier in the course of RA and show an increase in specificity compared to RF, with 20-30% of RF seronegative RA patients being positive for CCP antibodies.

Who should be tested?

The 2010 Rheumatoid Arthritis Classification Criteria from the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) includes CCP antibody testing, along with RF, as part of its criteria for assessing rheumatoid arthritis. The ACR recommends that patients with at least 1 joint with definite clinical swelling, not explained by another disease, should be tested for RA.  According to the ACR, CCP antibodies may be detected in about 50-60% of people with early RA, as early as 3-6 months after the beginning of symptoms. Early detection and diagnosis of RA allows aggressive treatment of the condition, minimizing the associated complications and tissue damage.

References:

Content has been provided by Labtestsonline.org

  1. van Venrooij, W. J., van Beers, J. J. B. C. & Pruijn, G. J. M. Anti-CCP antibodies: the past, the present and the future. Nature reviews. Rheumatology 7, 391–8 (2011).
  2. Agarwal, S. K. Core management principles in rheumatoid arthritis to help guide managed care professionals. Journal of managed care pharmacy : JMCP 17, S03–8 (2011).
  3. Farid, S.S., Azizi G. & Mirshafiey A. Anti-citrullinated protein antibodies and their clinical utility in rheumatoid arthritis. International J of Rheumatic Diseases 16, 379-86 (2013).

Patient Frequently Asked Questions(FAQs)

​How is it used?

A cyclic citrullinated peptide (CCP) antibody test may be ordered along with or following a rheumatoid factor (RF) test to help diagnose rheumatoid arthritis (RA) and to assess the severity and probable course of the disease (prognosis). CCP antibody may also be ordered to help evaluate the likely development of RA in people.

When is it ordered?

A CCP antibody test is primarily ordered along with an RF test when someone has signs and symptoms that may be due to previously undiagnosed inflammatory arthritis or has been diagnosed with undifferentiated arthritis. It may be ordered as a follow-up test to a negative RF test when clinical signs and symptoms lead the doctor to suspect RA. RA usually affects multiple joints symmetrically. Signs and symptoms may include:

  • Painful, warm, swollen joints of the hands and wrists most commonly
  • Pain sometimes affecting elbows, neck, shoulders, hips, knees, and/or feet
  • Stiffness of affected joints in the morning that improves during the course of the day
  • Fatigue
  • Fever
  • Development of nodules under the skin, especially at the elbows
  • A general feeling of being unwell (malaise)

What does the test result mean?

When people with signs and symptoms of arthritis are positive for both CCP antibody and RF, it is very likely that they have RA and that they may develop a more severe form of the disease. When people are positive for CCP antibody but not RF, or have low levels of both, and have clinical signs that suggest RA, then it is likely that they have early RA or that they will develop RA in the future.

When individuals are negative for CCP antibody but have a positive RF, then the clinical signs and symptoms are more vital in determining whether they have RA or some other inflammatory condition. When someone is negative for both CCP antibody and RF, then it is less likely that they have RA. It must be emphasized, however, that RA is a clinical diagnosis and may be made in the absence of positive tests for autoantibodies.

Is there anything else I should know?

The CCP antibody test is relatively new. It is becoming more widely used but is still less frequently ordered than the RF test.

CCP antibodies are rarely found in other autoimmune conditions, such as lupus, Graves' disease and Sjögren's syndrome, and may rarely be detected in viral infections such as hepatitis C.

Will my CCP antibody ever go away?

Like other autoantibodies, once developed by the body's immune system, levels of CCP may fluctuate over time but will not go away.

What other tests might my doctor order in evaluating me for RA?

Your doctor may choose to order an ESR and/or CRP, tests that detect inflammation. They may also order a CBC to check for a high white blood cell count, another sign of inflammation and to check for anemia, a condition common in people with RA. For added information, imaging, such as an X-ray and an analysis of joint fluid (synovial fluid) may be performed to evaluate the affected joints. In addition, your doctor may also order antinuclear antibody (ANA) testing. A negative ANA helps exclude SLE and other systemic rheumatic diseases; the ANA may be positive in up to one-third of patients with RA.

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