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80%) second-generation ELISA has been developed and marketed for the diagnosis of RA using cyclic citrullinated peptide as antigen (CCP). Population based studies indicate that finding multiple RF isotypes or antifilaggrin antibodies (synonymous with anti-CCP) in apparently normal individuals is highly predictive for the development of RA in subsequent years. More importantly, these markers are being recognized as indicative of disease course. Monitoring C-reactive protein and erythrocyte sedimentation rate continue to be a mainstay for determining RA disease activity, although acute-serum amyloid A may be a more sensitive marker for synovial inflammation.
doi:10.1016/j.cccn.2005.03.030 
Copyright © 2005 Elsevier B.V. All rights reserved.
Proteomic: New advances in the diagnosis of rheumatoid arthritis
Received 4 March 2005;
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Abstract
Background
Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting the joints. A number of novel treatment modalities have been introduced over the past years, and rheumatologists are now attempting to institute optimal treatment in recent-onset arthritis. To facilitate diagnosis during the early stages of disease, when often not all clinical symptoms are manifest, a good serological marker is needed.
Methods
Antibodies directed to citrullinated proteins provide this ability. The most sensitive assay for detecting these antibodies is the so-called anti-cyclic citrullinated peptide, second generation (CCP II) enzyme-linked immunosorbent assay (ELISA).
Results
The diagnostic and prognostic potential of anti-CCP antibodies and the availability of a fully automated assay method lead us to conclude that the test is satisfactory for routine use as a serological marker of RA. In addition, we consider the potential of multiplex autoantibody assays, including miniaturized, high-throughput microarray technology, to improve diagnosis and prognostication in early onset arthritis patients.
Keywords: Rheumatoid arthritis (RA); Early arthritis; Rheumatoid factor (RF); Citrullinated peptide (CCP); Enzyme linked immunosorbent assay (ELISA); Microarray technology
Abbreviations: ACR, American College of Rheumatology; RA, rheumatoid arthritis; RF, rheumatoid factor; APF, anti-perinuclear factor; AKA, anti-keratin antibodies; ELISA, enzyme linked immunosorbent assay; CI, confidence interval; ROC, receiver operating characteristic
