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Anti-CCP vs RF Specificity — SCE Rheumatology MCQ

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HardAutoimmune SerologyAnti-CCP vs RF SpecificitySCE Rheumatology

A patient with symmetrical small-joint synovitis has positive rheumatoid factor and anti-CCP antibodies. Why does anti-CCP provide greater diagnostic specificity for rheumatoid arthritis?

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Correct answer: AAnti-CCP recognizes citrullinated epitopes strongly associated with rheumatoid arthritis

The best answer is “Anti-CCP recognizes citrullinated epitopes strongly associated with rheumatoid arthritis”. Anti-CCP antibodies are highly specific but not universally sensitive for rheumatoid arthritis. Rheumatoid factor targets the Fc portion of IgG and can occur in chronic infection, other autoimmune disease and healthy older adults. The assays therefore do not detect the same target, and neither result substitutes for clinical evidence of synovitis.

Reference: NICE NG100 rheumatoid arthritis investigations: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations