Anti-cyclic citrullinated peptide antibodies (Anti-CCP-Abs)
Blood Tests

Author: Gianpiero Pescarmona
Date: 15/02/2010



Anti-citrullinated protein/peptide antibodies (ACPAs) are autoantibodies (antibodies directed against one or more of the individuals own proteins) frequently detected in rheumatoid arthritis patients. During inflammation, citrulline is incorporated enzymatically into proteins, what is called citrullination

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Citrullinated Peptide

Acta Reumatol Port. 2009 -;34(4):608-612.
Anti-cyclic citrullinated peptide antibodies and rheumatoid factor in Siogren's syndrome. 2009
Barcelos F, Abreu I, Patto JV, Trindade H, Teixeira A.

Portuguese Institute of Rheumatology, Lisbon, Portugal.
Objectives: The purpose of this study was to evaluate the prevalence and clinical significance of anti-cyclic citrullinated peptide antibodies (anti-CCP-Abs), IgM and IgA rheumatoid factors (RFs) in primary Siogren's Syndrome (pSS). Materials and Methods: We compared clinical and serological characteristics of 31 pSS and 31 Rheumatoid Arthritis (RA) patients. Both, anti-CCP-Abs and RFs (IgM, IgA) directed against Fc determinants of IgG from humans and rabbit were detected by enzyme-linked immunosorbent assay (ELISA). We included 31 blood donors as control group for the evaluation of RFs and anti-CCP-Abs. Nine (29%) pSS patients presented arthritis, and 10 (32,3%) RA patients also had secondary Siogren's syndrome (sSS) Results: IgM and IgA RFs prevalence was similar in pSS and RA, whichever the antigene (Human or Rabbit IgG) used. However, RA patients with sSS showed a tendency to present more often RF positivity, longer disease duration and higher ESR and CRP when compared with pSS patients with arthritis. Anti-CCP-Abs were detected in 64,5% of RA patients and in only 6,9% of pSS patients (p<0,0005). Anti-CCP-Abs were more often positive in RA patients with sSS (RA/sSS) (8 patients, 80%) than in RA patients without sSS (18 patients, 58,1%), and were absent in pSS patients with arthritis. RF-positive pSS patients presented more often pulmonary involvement and higher inflammatory parameters, and less often neuropathy compared to RF-negative patients. In controls, anti-CCP-Abs were absent and RFs were negligible. Conclusions: Anti-CCP-Abs were detected in only a few pSS patients, none of whom presented arthritis, which contrasts with the high frequency of these antibodies in RA/sSS. These results suggest that anti-CCP-Abs could be useful in the distinction between pSS and RA with sSS. Although not useful for the differential diagnosis between RA and pSS,


Specificity, sensitivity etc.

Diagnostic Algorithms


Open Questions

Induction of macrophage secretion of tumor necrosis factor alpha through Fcgamma receptor IIa engagement by rheumatoid arthritis-specific autoantibodies to citrullinated proteins complexed with fibrinogen. 2009

  • The 2 citrullinated peptides significantly inhibited ACPA reactivity to citrullinated fibrinogen and, when tested together, almost completely abolished formation of macrophage-activating ICs, thereby diminishing the secreted TNFalpha levels.

Working Hypothesis


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