Anti-CCP antibody Prevention of rheumatism. blood test Relationship between anti-CCP antibody value and rheumatism.

What is anti-CCP antibody ?
If you are told that anti-CCP antibody is positive ... When should you start treatment?

Tokyo Arthritis Clinic Dr.Fujio Alex Amamoto

What is anti-CCP antibody?

In diagnosing and treating rheumatism, the most important thing now is the anti-CCP antibody blood test item.

We have examined this anti-CCP antibody for nearly 12 years in almost all patients who suspect rheumatism or rheumatism.

That number will be over 10,000 people.

From that many experiences, I have known.

What we know from recent research.

The value of anti-CCP antibody is proportional to the severity of rheumatism with a high probability.

  1. If it is positive, it develops serious rheumatoid arthritis within a few years (several months to about 5 years).
  2. If it occurs, deformity will progress severely within 1 - 3 years unless sufficient treatment is done at an early stage.
  3. Even with the same positive, the higher the number, the stronger the momentum of the disease. Evidence literature # 1 # 2
  4. Some people who are completely asymptomatic even if they are positive for anti - CCP antibodies, or occasionally only have mild pain, but within 10 years there is a high probability of developing rheumatoid arthritis.
  5. Anti-CCP antibody positive rate of Japanese healthy volunteers 1.5-2% (estimated from data of human dock)

What we can deduce from our clinical experience.

More than 100 people with anti-CCP antibodies often require biologics as well as MTX. (Impression that about 80% or more)

On the other hand, if the anti-CCP antibody is 100 or less, the rate of remission can be remarkable only with MTX. (Impression that about 30-40%)

If medicine works, rheumatism improves and the value also decreases.

However, symptoms have a time lag.

The effect of lowering the figure of anti-CCP antibody (and rheumatoid factor) is greater MTX.

On the other hand, biologic preparations such as etanercept / enbrel (anti-TNFα preparation) have a weak ability to lower the number even if medicine is effective.

Currently long-term investigation is being conducted on the effect of lowering the anti-CCP antibody of a new type of biologic (Actemra, Orencia, etc.). It is going through in our hospital.

Is it useful for judging the therapeutic effect of rheumatism?

Anti-CCP antibody is useful not only for initial diagnosis but also for judgment of therapeutic effect.

Is the anti-CCP antibody the cause of rheumatism?

It is known that anti-CCP antibody is closer to the fundamental cause of rheumatic onset than other tests.

In other words, it can be said that it has almost the same meaning as genetic testing of rheumatism.

However, it is not decided whether the anti-CCP antibody is naturally positive or not.

I know that what is normal until now will be positive. (There is a range from teens to over 70 years old)

At the moment the genes can not be changed, but there are cases where early treatment lowers to the normal range.

It happened that the anti-CCP antibody was positive in the examination,
but now there are no symptoms. Can you prevent the onset of rheumatism by lowering this number?

We have never done medication treatment for patients who are positive for anti-CCP antibody and are completely asymptomatic.

However, the result of early administration of MTX to many patients with mild disease said "It is too early to start therapy yet" in other hospitals, so from now on, treatments targeting the numbers themselves will also be I think that it is possible.

Also, basic research on anti-CCP antibody and epidemiologic research also show many results that affirm such a way of thinking (prevention from pre RA condition).

Can not it be used to judge the therapeutic effect?

I would also like to confirm that anti-CCP antibody has declined when the disease improves with medicine.

You can use it. Just because of insurance constraints, we can not measure often.

After diagnosis of rheumatism, measurement only for judgment of biological product change judgment is allowed. Because it is a relatively expensive inspection, I believe it is reasonable to measure about once a year.

When examining anti-CCP antibody, it came out with more than 100, but what is it exactly?

Many medical institutions can not measure figures for items with a high value of 100 or more due to differences in inspection methods.

At Tokyo Rheumatology Clinic, it is possible to measure whether it is 200 or 500 or 1,000 even if it is 100 or more.

Some 3,000 - 4,000 are also available. After all, such people often have strong momentum of rheumatism.

If you go to a high price you will get different ways to cure your treatment, so (that is, we will increase MTX early, start biologics) I'd like to know how many again.

We recommend that you check the measured values once.

Prevention of the occurrence of rheumatoid arthritis "Start of MTX administration immediately in patients with arthritis positive for anti-CCP antibody"

Rheumatoid onset was significantly suppressed by early administration of MTX to patients with anti-CCP antibody positive UA in the PROMPT study which examined the effectiveness of MTX on undiagnosed arthritis (UA).

Reference citation

Is remission possible for rheumatoid arthritis possible―Fredinand C.Breedveld APLAR 2010

Undiagnosed arthritis (UA) is a disease state in which symptoms of arthritis are observed but RA (rheumatism) diagnostic criteria are not satisfied and other arthritis is not diagnosed, about 30% of patients are confirmed as RA with one year later It is known that natural remission occurs in some patients. In the PROMPT study ( van Dongen H et al. Arthritis Rheum 2007; 56 (5): 1424-1432 ) which examined the effectiveness of MTX on UA, RA onset was significantly suppressed in anti-CCP antibody positive UA patients (p = 0.0002), the progression of X-ray findings was also significantly suppressed (p = 0.03), but no effect was observed in anti-CCP negative cases, indicating that the effect of early MTX administration varies depending on the presence or absence of anti-CCP antibody . For that reason, Professor Breedveld pointed out, "For patients with UC who are positive for anti-CCP, it is important to start treatment immediately instead of follow-up and to suppress progression to RA."

Evidence literature

#1 Berglin E,Johansson T,Sundin U,et al:Radiological outcome in rheumatoid arthritis is predicted by presence of antibodiesagainst cyclic citrullinated peptide before and at disease onset,and by IgA-RF at disease onset.―

#2 Syverrsen SW,Gaarder PI,Gokk GL,et al:High anti-CCP levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: results from a 10-year longitudinal study―

Alessandri C,Bombardieri M,Papa N,et al:Decrease of anti-cyclic citrullinated peptide antibodies and rheumatoid factor following anti-TNFα therapy (infliximab) in rheumatoid arthritis is associated with clinical improvement―

Caramaschi P,Biasi D,Tonolli E,et al:Antibodies against cyclic citrullinated peptides in patients affected by rheumatoid arthritis before and after infliximab treatment―

De Rycke L,Verthlst X,Kruithof E,et al:Rheumatoid factor, but not anti-cyclic citrullinated peptide antibodies, is modulated by infliximab treatment in rheumatoid arthritis―

van Dongen H et al.Arthritis Rheum 2007;56(5): 1424-1432 Efficacy of Methotrexate Treatment in Patients With ProbableRheumatoid Arthritis

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