Clinical utility of anti-CCP antibodies in the differential diagnosis of elderly-onset rheumatoid arthritis and polymyalgia rheumatica

• Published in: Rheumatology (Oxford, England) Vol. 43; no. 5; pp. 655 - 657
• Main Authors: Lopez-Hoyos, M., Ruiz de Alegria, C., Blanco, R., Crespo, J., Peña, M., Rodriguez-Valverde, V., Martinez-Taboada, V. M.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-05-2004; Oxford Publishing Limited (England)
• Subjects: Age of Onset; Aged; Aged, 80 and over; Anti-CCP antibodies; Arthritis, Rheumatoid - diagnosis; Autoantibodies - blood; Biological and medical sciences; Biomarkers - blood; Citrulline - immunology; Diagnosis, Differential; Diseases of the osteoarticular system; Elderly; Female; Humans; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Peptides, Cyclic - immunology; Polymyalgia rheumatica; Polymyalgia Rheumatica - diagnosis; Rheumatoid arthritis; Rheumatoid Factor - blood; Human; Immunopathology; Anti-CCP antibodies; Antibody; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Differential diagnostic; Chronic; Rheumatoid arthritis; Polymyalgia rheumatica; Elderly
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keh143

Background. In a significant number of patients the differential diagnosis between elderly-onset rheumatoid arthritis (EORA) and polymyalgia rheumatica (PMR) is very difficult because of the lack of specific serum markers. Anti-cyclic citrullinated peptide antibodies (anti-CCP Abs) have recently been shown to be highly specific for rheumatoid arthritis (RA). This is the first study addressing the utility of these antibodies in the differential diagnosis between EORA and PMR. Methods. Serum samples from 57 EORA patients and 49 PMR patients were studied for the presence of anti-CCP Abs and rheumatoid factor (RF). As controls, samples from 41 RA patients (age at onset <60 yr) and 24 aged healthy subjects were analysed. Results. Sixty-five per cent of EORA patients had anti-CCP Abs, whereas none of the PMR patients or the aged healthy subjects was positive for those antibodies. Ten of the EORA patients started with polymyalgic symptoms and two of them were positive for anti-CCP Abs. Interestingly, there was a significant correlation between anti-CCP Abs and RF in EORA but not in young RA patients. Conclusions. The presence of anti-CCP Abs in a patient with clinical symptoms of PMR must be interpreted as highly suggestive of EORA.