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Autoantibodies to citrullinated fibrinogen compared with anti-MCV and anti-CCP2 antibodies in diagnosing rheumatoid arthritis at an early stage: data from the French ESPOIR cohort
  1. Pascale Nicaise-Roland1,
  2. Leonor Nogueira2,3,
  3. Christophe Demattei4,
  4. Luc de Chaisemartin1,6,
  5. Nathalie Rincheval7,
  6. Martin Cornillet2,3,
  7. Sabine Grootenboer-Mignot1,
  8. Philippe Dieudé8,
  9. Maxime Dougados9,
  10. Alain Cantagrel10,
  11. Olivier Meyer8,
  12. Guy Serre2,3,
  13. Sylvie Chollet-Martin1,6
  1. 1UF Immunologie Autoimmunité et Hypersensibilités, APHP Hopital Bichat-Claude Bernard, Paris, France
  2. 2Biologie Cellulaire, Hopital Purpan, Toulouse, France
  3. 3UMR 5165 INSERM U1056, Universite de Toulouse III, Toulouse, France
  4. 4Biostatistiques et Epidemiologie, Hopital Caremeau, Nimes, France
  5. 5Inserm UMR996, Chatenay-Malabry F-92296, France
  6. 6Université Paris Sud, Faculté de Pharmacie, Chatenay-Malabry, 92296, France
  7. 7IURC, Université Montpellier, Montpellier, France
  8. 8Rhumatologie, APHP, Hopital Bichat-Claude Bernard, Paris, France
  9. 9Rhumatologie, APHP Hopital Cochin, Paris, France
  10. 10Rhumatologie, CHU Toulouse Purpan, Toulouse, France
  1. Correspondence to Pascale Nicaise-Roland, UF Immunologie Autoimmunité et Hypersensibilités, APHP Hopital Bichat-Claude Bernard, Paris, France; pascale.nicaise{at}


Objectives To compare the performance of anticitrullinated peptides/protein antibodies (ACPA) detected by three immunoassays in the French ESPOIR cohort of patients with early rheumatoid arthritis (RA) and undifferentiated arthritis (UA) and to study the relationship between ACPA and disease activity.

Methods A diagnosis of RA (1987 American College of Rheumatology (ACR) criteria) was established at baseline in 497 patients and after a 2-year follow-up in 592 patients. At baseline, antibodies to citrullinated fibrinogen (AhFibA), antimutated citrullinated vimentin (anti-MCV) and anticyclic citrullinated peptide (anti-CCP2) were assayed and the individual and combined diagnostic sensitivities and predictive values of the tests were determined. Relationships between ACPA positivity and the 28-joint disease activity score and Health Assessment Questionnaire scores were analysed.

Results At a diagnostic specificity of at least 98%, the three tests exhibited similar diagnostic sensitivities (47–48.5%). When considering as positive patients with at least one positive test, the sensitivity increased to 53.5% with a probable loss of specificity. Among the patients classified as having UA at baseline, 30% were positive for one ACPA, the positive predictive values for RA of the three tests ranging from 73% to 80% but increasing when two tests were associated. Whatever the test used, the addition of ACPA positivity to the 1987 criteria enhanced their sensitivity by 6%, close to that of the 2010 ACR/European League Against Rheumatism (EULAR) criteria.

Conclusions In early arthritis, AhFibA, anti-MCV and anti-CCP2 showed similar diagnostic sensitivity with a high diagnostic specificity and a similar high positive predictive value for RA. Adding ACPA to the 1987 ACR criteria significantly increased the number of patients classified as having RA, confirming the validity of the recent inclusion of the serological criterion in the ACR/EULAR criteria.

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  • Funding Fondation Arthritis Jacques Courtin, Société Française de Rhumatologie and Agence Nationale de la Recherche (ANR) (programme blanc France-Hongrie 2009; ANR-09-BLAN-0398-01) are acknowledged for providing grants to UMR CNRS 5165-INSERM 1056-Université de Toulouse.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from the Montpellier ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.