Serum anti-cyclic citrullinated peptide antibodies before and after treatment by disease-modifying anti-rheumatic drugs

Nasrin Moghimi, Faeisal Farshadi, Mahin Lashkari, Ali Delpisheh, Abdorrahim Afkhamzadeh, Namamali Azadi

DOI: 10.22122/cdj.v2i2.64


BACKGROUND: Rheumatoid arthritis (RA) is the most common chronic disease involving joints. Anti-cyclic citrullinated peptide (anti-CCP) as a specific antibody is a reliable index to early diagnosis of RA. Disease-modifying anti-rheumatic drugs (DMARDs) can reduce progression of RA joint destruction. The present study aimed to investigate the effects of DMARDs in reducing serum anti-CCP.

METHODS: A cross-sectional study was performed on 30 patients including 22 females and 8 males RA patients according to the American College of Rheumatology (ACR) classification criteria, who referred to the Rheumatology Clinic. Treatment with DMARD group started at the beginning of the study (May 2009). At 1st and 6th month of the study, clinical findings and disease activities were recorded and anti-CCP was measured.

RESULTS: At the beginning and the end of the study, morning stiffness for more than 1 h and involvement of three areas were, 28 (93%) and 12 (40%), respectively. Indicators of disease severity in patients, the mean ± SD serum levels of erythrocyte sedimentation rate at the beginning and end, were 40.7 (30-59) mm/1 h and 13.4 (9-86) respectively. Anti-CCP at the beginning and end of the study was 141.83 (65.8-101.09) U/ml and 65.8 (62-92) U/ml respectively (P < 0.05). Disease Activity Score in 28 joints and rheumatoid factor positive and C-reactive protein positive were significantly different at the onset and at the end of the study (P < 0.05).

CONCLUSION: Measurement of serum anti-CCP is a helpful index of treatment response and monitoring of treatment efficacy in patients with RA.



Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Antibodies, Disease-Modifying Anti-Rheumatic Drug Group

Full Text:



Harris E, Budd R, Firestein G, Genovese M. Kelley's textbook of rheumatology. 7th ed. Philadelphia, PA: Elsevier/Saunders; 2005.

Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 2008.

Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31(3): 315-24.

van Venrooij WJ, Hazes JM, Visser H. Anticitrullinated protein/peptide antibody and its role in the diagnosis and prognosis of early rheumatoid arthritis. Neth J Med 2002; 60(10): 383-8.

Schellekens GA, Visser H, de Jong BA, van den Hoogen FH, Hazes JM, Breedveld FC, et al. The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Arthritis Rheum 2000; 43(1): 155-63.

Matsui T, Shimada K, Ozawa N, Hayakawa H, Hagiwara F, Nakayama H, et al. Diagnostic utility of anti-cyclic citrullinated peptide antibodies for very early rheumatoid arthritis. J Rheumatol 2006; 33(12): 2390-7.

Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis Rheum 2002; 46(2): 328-46.

Meyer O, Labarre C, Dougados M, Goupille P, Cantagrel A, Dubois A, et al. Anticitrullinated protein/peptide antibody assays in early rheumatoid arthritis for predicting five year radiographic damage. Ann Rheum Dis 2003; 62(2): 120-6.

Lindqvist E, Eberhardt K, Bendtzen K, Heinegard D, Saxne T. Prognostic laboratory markers of joint damage in rheumatoid arthritis. Ann Rheum Dis 2005; 64(2): 196-201.

Elkayam O, Segal R, Lidgi M, Caspi D. Positive anti-cyclic citrullinated proteins and rheumatoid factor during active lung tuberculosis. Ann Rheum Dis 2006; 65(8): 1110-2.

de Vries-Bouwstra JK, Goekoop-Ruiterman YP, Verpoort KN, Schreuder GM, Ewals JA, Terwiel JP, et al. Progression of joint damage in early rheumatoid arthritis: association with HLA-DRB1, rheumatoid factor, and anti-citrullinated protein antibodies in relation to different treatment strategies. Arthritis Rheum 2008; 58(5): 1293-8.

Chen HA, Lin KC, Chen CH, Liao HT, Wang HP, Chang HN, et al. The effect of etanercept on anti-cyclic citrullinated peptide antibodies and rheumatoid factor in patients with rheumatoid arthritis. Ann Rheum Dis 2006; 65(1): 35-9.

Ronnelid J, Wick MC, Lampa J, Lindblad S, Nordmark B, Klareskog L, et al. Longitudinal analysis of citrullinated protein/peptide antibodies (anti-CP) during 5 year follow up in early rheumatoid arthritis: anti-CP status predicts worse disease activity and greater radiological progression. Ann Rheum Dis 2005; 64(12): 1744-9.

Mikuls TR, O'Dell JR, Stoner JA, Parrish LA, Arend WP, Norris JM, et al. Association of rheumatoid arthritis treatment response and disease duration with declines in serum levels of IgM rheumatoid factor and anti-cyclic citrullinated peptide antibody. Arthritis Rheum 2004; 50(12): 3776-82.

Bobbio-Pallavicini F, Alpini C, Caporali R, Avalle S, Bugatti S, Montecucco C. Autoantibody profile in rheumatoid arthritis during long-term infliximab treatment. Arthritis Res Ther 2004; 6(3): R264-R272.

Nissinen R, Leirisalo-Repo M, Peltomaa R, Palosuo T, Vaarala O. Autoantibody profile in rheumatoid arthritis during long-term infliximab treatment. Ann Rheum Dis 2004; 3: 681-7.

Braun-Moscovici Y, Markovits D, Zinder O, Schapira D, Rozin A, Ehrenburg M, et al. Anti-cyclic citrullinated protein antibodies as a predictor of response to anti-tumor necrosis factor-alpha therapy in patients with rheumatoid arthritis. J Rheumatol 2006; 33(3): 497-500.

Kakumanu P, Sobel ES, Narain S, Li Y, Akaogi J, Yamasaki Y, et al. Citrulline dependence of anti-cyclic citrullinated peptide antibodies in systemic lupus erythematosus as a marker of deforming/erosive arthritis. J Rheumatol 2009; 36(12): 2682-90.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.