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Diagnostic Performance and Predictive Value of Rheumatoid Factor, Anti-citrullinated Peptide Antibodies, and the HLA Shared Epitope for Diagnosis of Rheumatoid Arthritis

¹ Rheumatology, Ghent University Hospital, Ghent, Belgium ² Innogenetics, Ghent, Belgium ³ Rheumatology, St-Augustinus Hospital, Wilrijk, Belgium ⁴ Locomotor Center, Elisabeth Hospital, Sijsele, Belgium

^aaddress correspondence to this author at: Rheumatology, Ghent University Hospital, 9000 Ghent, Belgium; fax 32-9-240-3803, e-mail Ilse.Hoffman@UGent.be

The first 300 words of the full text of this article appear below.

Rheumatoid factor (RF) is currently the most accepted laboratory test for rheumatoid arthritis (RA) and is part of the revised American College of Rheumatology (ACR) classification criteria for RA (1). The specificity of RF is, however, often low (2)(3)(4)(5). A newer diagnostic marker for RA is anti-citrullinated peptide antibodies (ACPAs), which can be identified by tests such as a line immunoassay (LIA^TM) for the detection of anti-pepA and anti-pepB antibodies (6), the anti-cyclic citrullinated peptide ELISA (7), an ELISA using citrullinated recombinant rat filaggrin (8), and an ELISA using deiminated fibrinogen (9). ACPAs have excellent specificity (89–100%) for RA, with good sensitivity (41–80%) (3)(4)(5)(6)(7)(10)(11)(12)(13)(14)(15). Furthermore, the HLA shared epitope (SE) has been described, which is found more often in RA patients than in controls (16)(17)(18). Most studies of these newer tests have used control populations consisting of selected groups of patients with defined diseases and healthy controls. This does not represent real-life clinical practice because the composition of the control group does not reflect the natural prevalences of diseases in cases for which serologic markers for RA are requested. Data about specificity, positive predictive value (PPV), and negative predictive value (NPV) are thus hard to interpret. We designed the present study to reflect everyday rheumatology practice.

In this prospective study, we included 1003 consecutive patients in three academic and nonacademic centers: the Department of Rheumatology, Ghent University Hospital (Ghent, Belgium); the Locomotor Center, Elisabeth Hospital (Sijsele, Belgium); and the Department of Rheumatology, St-Augustinus Hospital (Wilrijk, Belgium). Patients were entered in the study when . . . [Full Text of this Article]

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