High Positive Anti-CCP Score — SCE Rheumatology MCQ

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EasyAutoimmune SerologyHigh Positive Anti-CCP ScoreSCE Rheumatology

A 55-year-old woman with clinical synovitis in at least one joint and no better alternative diagnosis is being assessed using the 2010 ACR/EULAR rheumatoid arthritis classification criteria. Rheumatoid factor is negative. Her anti-CCP concentration is 350 U/mL, with a laboratory upper limit of normal of 20 U/mL. How many points are assigned in the serology domain?

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Correct answer: D — 3 points

The correct answer is D. Under the 2010 ACR/EULAR rheumatoid arthritis classification criteria, high-positive RF or ACPA, including anti-CCP, is defined as a concentration greater than three times the assay-specific upper limit of normal and scores 3 points. Here, 350/20 = 17.5 times the ULN, so the anti-CCP result is high-positive. A low-positive result—above the ULN but no more than three times the ULN—would score 2 points, while negative RF and ACPA would score 0. One point is used in other criteria categories, such as an abnormal acute-phase response or symptom duration of at least 6 weeks; 5 points is the maximum joint-involvement score, not a serology score.

Reference: Aletaha D, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Serology domain and Table 3. Ann Rheum Dis. 2010;69:1580–1588. https://ard.bmj.com/content/69/9/1580