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Clinical value of second- and third-generation assays of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis
  1. K Kitahara1,2,
  2. K Takagi1,
  3. Y Kusunoki1,
  4. S Nishio1,
  5. T Nozaki3,
  6. H Inomata3,
  7. M Takei3,
  8. S Sawada3,
  9. S Kawai1
  1. 1
    Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
  2. 2
    Department of Immunology, Toho University School of Medicine, Tokyo, Japan
  3. 3
    Division of Haematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
  1. Professor S Kawai, Division of Rheumatology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan; skawai{at}

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Anti-cyclic citrullinated peptide (CCP) antibodies are useful for the diagnosis of rheumatoid arthritis (RA) because of their higher specificity.1 First-generation anti-CCP (CCP1) ELISAs were based on synthetic peptides derived from human filaggrin.2 The second-generation anti-CCP (CCP2) test, which contains epitopes selected from libraries of citrullinated peptides, performs better than anti-CCP1.3 4 Recently, a third-generation anti-CCP (CCP3) test was introduced. We compare the performance of the anti-CCP3 test with that of two anti-CCP2 tests, and assess their value in diagnosing RA.

A total of 502 participants were studied: 227 patients fulfilling the American College of Rheumatology criteria for RA,5 173 patients with non-RA autoimmune diseases (details are indicated …

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