Just what is the anti-CCP test?

[kageyd]

I found myself wanting to know more about the anti-CCP test. Here are two quoted snippets that, for me, cut through the more fuzzy scientific wordings to get to what we really want to know. Perhaps this will be of interest to others. It seems clear to me after reading more that specific numbers of anti-CCP, except in a general “high low” sense, are not yet of direct usefulness in treatment. Italics and bold lettering is mine.

1. What is cyclic citrulline peptide (antibody)y, anti-CCP, quoted from MedicineNet.com: “Citrulline antibody: An antibody … directed against a circular peptide … containing an unusual ("non-standard") amino acid called citrulline that is not normally present in peptides or proteins. … The citrulline antibody provides the basis for a test of importance in rheumatoid arthritis.

“The citrulline antibody appears early in the course of rheumatoid arthritis and is present in the blood of most patients with the disease. When the citrulline antibody is detected in a patient's blood, there is a 90-95% likelihood that the patient has rheumatoid arthritis. The test for the citrulline antibody is therefore useful in the diagnosis of patients with unexplained joint inflammation, especially when the traditional blood test for rheumatoid factor is negative. The citrulline antibody also has prognostic (predictive) value since it is associated with a greater tendency toward more destructive forms of rheumatoid arthritis.”


2. The meaning of the anti-CCP test, from the website of the American College of Rheumatology: “Several observations have indicated that anti-CCP positive early RA patients may develop a more erosive disease than those without anti-CCP (6). Other investigators have confirmed this, and suggested the superiority of anti-CCP over RF [Rheumatoid Factor] in predicting an erosive disease course. The use of anti-CCP results in the decision whether a patient should be treated aggressively at an early stage or not is an important area for research.”

[Paula]

Excellent synopsis, kageyd! I have posted this elsewhere, but according to an arthritisinsight.com post, these are the test ranges (I apologize for not finding a more scientific source - I have googled forever!)

"The ranges are:
weak positive: 20-39
moderate positive: 40-59
strong positive: >60"

I have read inquiries online of persons who had tested "over 250", as I have recently - I believe the lab test results that come back as "over 250" will probably not specify the "score". My doctor was reading directly from the lab report when she told me my findings of "over 250", and I am positive she would have said "291" or whatever if that number had come back from the lab.

I found a very recent article about a company (in India, I believe) that is preparing to sell anti-ccp kits - I assume to end consumers? Here is the article:


http://frontierindia.net/pharma/new-anti-ccp-test-for-rheumatoid-arthritis-on-bio-rad%C2%B4s-bioplex-2200-system/632

[kageyd]

Yeah, I've looked too Paula. I think the reality is that the CCP can be low or high because the things that it hooks up with in the blood are not a fixed entity. I've run a couple of these articles by my sciencey spouse, and he says it's clear to him that there are just too many things (he prefers to call them variables) that affect precisely how much the immune system is responding - and also that the immune system is very, very complicated, and consists of whole families of different antibodies that are always going up or down depending on what's going on in the body on a given day - for reasons that are not clear yet, and in response to triggers that are slowly being unwound but remain under active investigation.

In other words, we don't know enough yet!! But everybody seems pretty clear that a high CCP is not good. Lucky you, huh! Let's hope the Enbrel brings all those numbers down.

(I have this same number problem with my coumadin; it needs to be in a very limited range, but for reasons absolutely unknown, every few weeks it just jumps way over or way under, and then I have to adjust dosage to haul it back into range, and then I have to have it checked weekly until it's back in again. We know the number is responsive to certain things in the diet (like spinach for instance), but when it flips and we try to figure out why, just no way and we're both good detectives. So I guess I'm accustomed to uncertainty in the numbers game.)

[Paula]

kageyd: Guess what I did all by myself for the first time today? Yep, my first Enbrel injection...it was so easy and painless. My doctor also prescribed Prednisone; it is awaiting me at the pharmacy, but I am still on the fence. I seriously doubt if I take it for just a little while I will have the dreaded weight gain - but I guess I want to see if the Enbrel helps without other drugs as well.

FYI on Enbrel delivery - the shipper had said I did not necessarily have to be home to receive shipment, but I seriously doubt that is correct. It arrived via Fedex and the deliverer required my signature (also warning labels on box that signature was required). That makes sense when an expensive injectible drug is being delivered, but now I have to arrange for someone to be home every four weeks...oh, well. The good news is, I will be acquiring a nice inventory of mini ice coolers and freezer ice packs. :)

I always look forward to reading your enlightening posts!!

[kageyd]

Yes, Paula, I saw your other post about the first injection. Yay!!

FedEx will make at least three delivery attempts, telling you approximately (emphasis on the approximately) when they will be back (the next day sometime). They also, as I remember, give you a phone number to consult with about delivery, and they usually also give you an option to pick it up. Depending upon where the pick up spot is, that's an alternative. Possible suggestion if you have problems: change the delivery address to your husband's station, where someone can always sign for it even if he's not there on duty at the time -- don't know if the company would go along with it, but it might be worth a try. (Once you've lived in as many places as we have, over as many decades, you figure out all kinds of strategies to get your mail and your packages. We've learned that "forwarding" by Post Office is the most potentially dangerous - we once lost two weeks mail completely, never showed up anywhere at all.)

Take care, and thanks for the updates (and the kind words). Kageyd