Long-term follow-up of patients with anti-cyclic citrullinated peptide antibody-positive connective tissue disease: a retrospective observational study including information on the HLA-DRB1 allele and citrullination dependency. We retrospectively investigated whether anti-CCP-positive non-RA CTD patients developed RA and attempted to identify factors that may differentiate RA-overlapping CTD from pure CTD. In most cases, a positive ANA test indicates that your immune system has launched a . X-rays of the hands and feet were taken for all patients in groups 1 and 2, and in 25 out of 31 patients in group 3. Ioan-Facsinay A, Willemze A, Robinson DB, Peschken CA, Markland J, van der Woude D, et al. The positive predictive value (PPV) of anti-CCP antibody for erosive arthritis was calculated in each disease subset (n=65, groups 1, 2, and 3 with X-ray images in Fig. Ann Rheum Dis. A CCP antibodies test measures the level of these autoantibodies. Background/Purpose: A large multicenter healthcare system recently adopted multiplex immunoassay as an initial screen for antinuclear antibody (ANA) with confirmatory reflex testing by immunofluorescence antibody assay (IFA). Required fields are marked *. Prevalence of arthritis in anti-CCP-positive non-RA CTD patients is shown in Supplementary Table1, Additionalfile2. Citrullination dependency was more common in patients with SE, although it was not statistically significant (p=0.11) (Fig. INOVA Diagnostics; 02/2020). Almost all patients with lupus have a positive ANA test. Rheumatology (Oxford). The anti-CCP antibody test measures your bodys level of antibodies that commonly target specific proteins found in the joints. van de Stadt LA, de Koning MH, van de Stadt RJ, Wolbink G, Dijkmans BA, Hamann D, et al. (3,4,8,9) Compared to early serologic tests for RA including RF, several studies have demonstrated that ACPA have much improved specificity for RA. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. The false-positive rate of anti-CCP is difficult to come by. The anti-cyclic citrullinated peptide (CCP) antibody is a widely used diagnostic biomarker of rheumatoid arthritis (RA). The ANA test is not specific to any one disease, but a high level of ANA can be a sign of systemic lupus erythematosus (SLE). Preliminary criteria for classification of adult Still's disease. (1) Clinically, RA is typified by progressive damage of synovial joints, inflammation, production of diverse autoantibodies, and variable extra-articular manifestations. There is a newer version of the test that has improved sensitivity, which reduces the chance of a false negative. 2014;66(12):181827. 1, 7.6%). Once a patient develops a positive anti-CCP, it will usually remain positive, despite remission. Blood Tests for Autoimmune Diseases - Verywell Health This might be partly due to strict criterion of threshold of citrullination dependency (absorbance difference between anti-CAP and anti-CCP 0.1) for low absorbance level samples. LymeMD: Elevated rheumatoid factor -- and anti-CCP antibodies - Blogger Clinical judgments were based on the following classification criteria: the American College of Rheumatology (ACR) 1997 criteria [17] or the new Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria [18] for SLE, the ACR 2012 classification criteria [19] for primary Sjgrens syndrome (pSS), the ACR 1980 classification criteria [20] for systemic sclerosis, the Bohan and Peter diagnostic criteria [21] for polymyositis/dermatomyositis, the Kasukawas criteria for mixed connective tissue disease (MCTD) [22], the Yamaguchi criteria for adult-onset Stills disease (AOSD) [23], and the Assessment in SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis [24]. Information is shared for educational purposes only. Cite 28th Dec, 2015 Kakumanu P, Sobel ES, Narain S, Li Y, Akaogi J, Yamasaki Y, et al. 2010 Sep;62(9):2569-2581, 3. These patients may develop RA in the future because the emergence of anti-citrullinated protein antibodies (ACPA), including the anti-CCP antibody, precedes the onset of RA [3,4,5,6]. However, it isnt a very sensitive marker, which means that a negative result does not necessarily rule out rheumatoid arthritis [10]. Joe Cohen flipped the script on conventional and alternative medicineand it worked. Anti-CCP antibodies can be detected in the early stages of RA, even before symptoms are present. Aliment Pharmacol Ther. About 70% of RA patients test positive for anti-CCP antibodies [4, 23]. MAMvd and LAT evaluated citrullination dependency by ELISA. The immune system then produces antibodies to attack these . Description of the definition of the follow-up length. Part of Undiagnosed Lyme can develop into chronic Lyme, cause debilitating mental health symptoms, spread throughout the body - for example, to the neurological system or the heart - and wreak havoc on patients' quality of life. We reported the first case of SLE manifestation . The presence of anti-SCL-70 (anti-topoisomerase) antibodies is highly specific to the diagnosis of diffuse scleroderma, while the presence of anti-centromere antibodies is highly specific to the diagnosis of limited scleroderma. Cookies policy. 2 We assessed isoagglutinin titers in a candidate for ABOi-living donor kidney transplantation (A to O) who was treated by a humanized anti-CD38 IgG monoclonal antibody (daratumumab) a week before for multiple myeloma. Rheumatoid factors are proteins produced by your immune system that can attack healthy tissue in your body. anti-citrulline antibody (anti CCP) - General Practice notebook X-rays were examined in 27 out of the 33 patients, and only one (3.7%) showed bone erosions. However, it has been shown that false postive serological results often occured while detecting antibodies directed against SARS-CoV-2 in patients with . Thirty-three anti-CCP-positive non-RA CTD patients were retrospectively followed up for the development of RA. Anti-citrullinated protein antibodies (ACPAs) are autoantibodies (antibodies to an individual's own proteins) that are directed against peptides and proteins that are citrullinated.They are present in the majority of patients with rheumatoid arthritis.Clinically, cyclic citrullinated peptides (CCP) are frequently used to detect these antibodies in patient serum or plasma (then referred to as . 26460649). Can a positive CCP & RF be present in disorders other than RA? - Patient Therefore, SE has potential as a genetic marker to distinguish RA from non-RA in the ACPA-positive population. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. If that is positive, that makes the diagnosis of RA much more likely meaning that the patient, even if aymptomatic now, is likely to develop it down the road. If you also test positive for RF, you likely have the disease [25]. However, the target population in the present study was pSS patients who were cross-sectionally evaluated, and RA-overlapping CTD patients were not excluded when anti-CCP antibody titers were measured. We thank all the attending physicians who substantially contributed to the acquisition of data. 2000 Jan;43(1):155-163, 7. Overview. 2008;67(4):46670. Antineutrophil Cytoplasmic Antibodies (ANCA) Test - MedlinePlus We also calculated the OR of developing RA for SE possession in patients with any smoking history (past smokers+current smokers, n=9) to account for any confounding effects of smoking on RA. In contrast, antinuclear antibodies often attack your body's own tissues specifically targeting each cell's nucleus. CTD patients were classified based on the diagnosis of rheumatoid arthritis (RA), anti- cyclic citrullinated peptide (CCP) antibody positivity, and clinical characteristics. RA was diagnosed according to the 1987 revised American College of Rheumatology classification criteria. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Ann Rheum Dis. Positive results for cyclic citrullinated peptide (CCP) antibodies may occur in some patients with systemic lupus erythematosus or other autoimmune, connective tissue diseases. SelfDecode has the strictest sourcing guidelines in the health industry and we almost exclusively link to medically peer-reviewed studies, usually on PubMed. Google Scholar. Arthritis Rheum. 3 a-iii, closed triangle), confirming the high specificity of anti-CCP antibodies to CCP. Fingerstick tests give you results within 10 minutes, allowing your doctor to give you immediate feedback [21]. Evaluating patients suspected of having rheumatoid arthritis (RA), Differentiating RA from other inflammatory arthritis or connective tissue diseases. Fusconi M, Vannini A, Dall'Aglio AC, Pappas G, Cassani F, Ballardini G, et al. (10) Based on these studies, there exist a subset of patients with RA who are negative for RF and ACPA IgG (seronegative) who must be diagnosed clinically or with use of emerging diagnostic tests. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements. Therefore, the discrepancy with the present results may be explained by differences in the target population and diagnostic criteria. A rheumatoid factor test measures the amount of rheumatoid factor in your blood. RF can also be found in patients that don't have rheumatoid arthritis at all. 2005;52(11):34338. 2005;52(12):38138. 2023 BioMed Central Ltd unless otherwise stated. Zhu JN, Nie LY, Lu XY, Wu HX: Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria? 2008;58(6):157681. the cause of COVID-19, which has affected more than 6million . Antibodies normally target harmful substances, such as . Majka DS, Deane KD, Parrish LA, Lazar AA, Baron AE, Walker CW, et al. A positive result by itself does not automatically lead to a diagnosis. Lupus Blood Test Results: What to Know | HSS Rheumatology Rheumatoid Factor - Medscape Patients who test positive for anti-CCP antibodies at the time of diagnosis are likely to progress more rapidly and develop more destructive forms of RA [13, 26, 11]. Ann Rheum Dis. However, we could not find any significant association of citrullination dependency with erosive disease (OR=4.4 (95% CI 0.3244), p value=0.3). Cyclic Citrullinated Peptide (CCP) Antibody (IgG) They are heterogenous and usually composed of immunoglobulin M (IgM). 1). A negative result by itself does not rule out the disease. TI, SN, and KO wrote the main manuscript. the false-positive rate in this subgroup was approximately 10%. Elkayam O, Segal R, Lidgi M, Caspi D. Positive anti-cyclic citrullinated proteins and rheumatoid factor during active lung tuberculosis. Anti-CCP is commonly produced when you have rheumatoid arthritis. Unlike anti-dsDNA, the Sm antibody does not change in titer during a lupus flare or in response to treatment so need not be monitored. Anti-CCP antibody titers were obtained from a retrospective chart review or measured using stored sera. 2006;65(7):84551. The anti-cyclic citrullinated peptide antibody (anti-CCP) test (which has a high specificity for rheumatoid arthritis), full blood count (cytopaenias are a feature of SLE), urinalysis (haematuria and/or proteinuria may be due to renal manifestations of autoimmune disease), serum complement proteins C3 and C4 (low complement can reflect . As a result, we found significant effect on developing RA (OR Inf (95% CI 0.7-Inf), p value 0.048). The prevalence of HLA-DRB1 SE was significantly higher in RA-overlapping CTD patients (p=0.01). Furthermore, the 2010 ACR/EULAR criteria were used to diagnose RA [26]. 1). Re-testing later on may be required in . SelfDecode is a personalized health report service, Clinical utility of anti-CCP antibodies in the differential diagnosis If not ordering electronically, complete, print, and send a, Although late RA prognosis may be linked to adverse consequences, early diagnosis has been reported to improve outcomes; notably reduced joint destruction or deformity, delayed radiologic progression, and decreased functional disability. The reactivities to CAP and CCP of sera from RA-overlapping CTD patients and non-RA CTD patients were measured by an in-house ELISA and absorbance values at 415nm, and the absorbance values of anti-CAP antibodies were subtracted from those of anti-CCP antibodies for each patient. If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please leave a comment or contact us at support@selfdecode.com. Anything over this level means that you test positive for the antibodies and anything below means you test negative [8]. Aggarwal R, Liao K, Nair R, Ringold S, Costenbader KH. Refining the complex rheumatoid arthritis phenotype based on specificity of the HLA-DRB1 shared epitope for antibodies to citrullinated proteins. When rheumatoid arthritis is present, the body is perceiving its own tissues, joints, and organs as foreign invaders. The presence of ANA antibodies at levels of 1:160 or higher are generally taken as a sign of lupus. Regulation of anti-cyclic citrullinated peptide antibodies in rheumatoid arthritis: contrasting effects of HLA-DR3 and the shared epitope alleles. Arthritis Rheum 1980;23(5):581590. Arthritis Rheumatol. 2019 Oct 25;57(11):1668-1679, Cyclic citrullinated peptide (CCP) antibodies in serum are detected by binding to the wells of a commercial microtiter plate coated with synthetic CCP. In the present study, we focused on differences in the citrullination dependency of the anti-CCP antibody. Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. Epstein-Barr Virus Laboratory Testing - Centers for Disease Control and Horizontal dashed lines in a and b represent the cut-off level (=0.1) of citrullination dependency. SI Abnormal Reports. Anti-CCP antibodies may also be detected in other inflammatory diseases and conditions involving the joints and connective tissue, including [4, 5, 6, 7]: Anti-CCP antibodies belong to a family of similar antibodies known as anti-citrullinated protein antibodies (ACPAs) [5]. Burgers LE, Raza K, van der Helm-van Mil AH: Window of opportunity in rheumatoid arthritis - definitions and supporting evidence: from old to new perspectives. 1 Introduction. We also investigated whether the 33 patients with anti-CCP-positive CTD subsequently developed RA by asking each attending physician to confirm their fulfillment of the 1987 revised ACR criteria over time. A blood sample is drawn from the patient and analyzed in a lab. To make a conclusive diagnosis, your doctor will take into account both of your antibody results in combination with CRP and ESR tests and any symptoms you have [25]. Arthritis Rheum. 2007;66(4):5116. They are continually monitored by our internal peer-review process and if we see anyone making material science errors, we don't let them write for us again. Different patterns of associations with anti-citrullinated protein antibody-positive and anti-citrullinated protein antibody-negative rheumatoid arthritis in the extended major histocompatibility complex region. it is found in Psoriatic arthritis, even leprosy, and as a false positive finding . Arthritis Rheum. All of our content is written by scientists and people with a strong science background. All authors approved the final manuscript. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Therefore, the clinical significance of the presence of the anti-CCP antibody in non-RA CTD patients remains unclear. (6,7) In addition to the use of RA and ACPA IgG to diagnose RA, RF and ACPA isotype antibodies and other serologic biomarkers have been used to predict if, and when, an individual who has inflammatory arthritis (IA) may develop future clinically apparent IA and access genetic and/or environmental risks. Association between SARSCoV2 and SLE is not clear. Avoiding CCP False Positives in Rheumatoid Arthritis Diagnosis - Fisher Sci CAS The anti-cyclic citrullinated peptide (CCP) antibody is a diagnostic biomarker of rheumatoid arthritis (RA). Limitations: The presence of immune complexes may cause false-positive results due to increased non-specific binding. These autoantibodies begin targeting and attacking otherwise healthy tissue. 2006;65(8):11102. Doctors use the anti-CCP antibody test in combination with other tests and symptoms to diagnose rheumatoid arthritis and determine the likely course of the disease. 2009;61(11):147283. K Ohmura: Received research grants and/or speakers fees from Abbvie, Actelion, Asahikasei Pharma, Astellas, AYUMI, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Janssen, JB, Mitsubishi Tanabe, Nippon Kayaku, Nippon Shinyaku, Novartis, Sanofi, and Takeda. a Comparison of citrullination dependency between rheumatoid arthritis (RA)-overlapping connective tissue diseases (CTD) and non-RA CTD patients. J Rheumatol. Although we considered an anti-CCP titer 100 to be 100, the relationship between the anti-CCP antibody titer and the risk of developing RA is supported by patients with a high ACPA level having a high score in the 2010 ACR/EULAR classification criteria of RA [26] as well as a high anti-CCP antibody titer being more strongly associated with RA in the general population [32]. This immune activation destroys healthy tissue in the joints and worsens RA symptoms [3]. Anti-CCP antibodies target proteins in which the amino acid arginine has been converted (citrullinated) into another amino acid called citrulline. Anti-CCP antibodies, also called CCP antibodies, are a type of antibody called autoantibodies. Environmental and genetic factors in the development of anticitrullinated protein antibodies (ACPAs) and ACPA-positive rheumatoid arthritis: an epidemiological investigation in twins. Lyme Disease and Rheumatoid Arthritis: Similarities, Differences and Clinical utility of the anti-CCP assay: experiences with 700 patients Many patients with other autoimmune disorders and inflammatory conditions test positive for rheumatoid factor but don't have rheumatoid arthritis. (2) We evaluated only anti-CCP-positive patients and did not re-evaluate the serology of anti-CCP negative CTD patients, some of whom may have newly developed anti-CCP antibody. Patients with chronic inflammatory diseases are often treated with immunosuppressants and therefore are of particular concern during the SARS-CoV-2 pandemic. Elsevier, Amsterdam. Low levels of anti-CCP can be found in the test results of certain patients but may not enough to produce a positive result. Rantapaa-Dahlqvist S, de Jong BA, Berglin E, Hallmans G, Wadell G, Stenlund H, et al. Anti-CCP (Cyclic Citrullinated Peptide) Anti-Citrullinated Ab. Significantly elevated levels of CCP antibodies may be useful to identify RA patients with erosive joint disease. An asterisk denotes the accuracy of the diagnosis was reconfirmed by a questionnaire completed by each attending physician, which asked whether the patient fulfilled the 1987 revised ACR criteria for the classification of RA. About 20% of RA patients are seronegative, meaning that their RF and anti-CCP lab results both continue to come back . 1988;31(3):31524. antibodies are routinely tested for by ELISA at Clinipath. Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by interactions between the environment, specific genetic risk factors, and the human immune system. Schellekens GA, Visser H, de Jong BA, et al: The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Clinical Utility of Common Serum Rheumatologic Tests | AAFP Based on his own health success, he went on to found SelfDecode, the worlds first direct-to-consumer DNA analyzer & precision health tool that utilizes AI-driven polygenic risk scoring to produce accurate insights and health recommendations. PubMed 2017 Jun;39(4):437-446, 8. 2011;70(12):21349. Google Scholar. We appreciate Dr. Xinghao Wang for the critical reading of the manuscript. The presence of CCP antibodies, when considered in conjunction with other laboratory and clinical findings, is an aid in the diagnosis of rheumatoid arthritis (RA). Long-term follow-up of patients with anti-cyclic citrullinated peptide Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. 2b). These antibodies react with CAP, which is the arginine version of CCP (the citrulline residues of CCP were replaced by arginine). Anti-citrullinated protein antibody - Wikipedia Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. RA Diagnosis: What Criteria are used to Diagnose Rheumatoid Arthritis? All data were analyzed anonymously. These antibodies are made as a direct attack of specific proteins found naturally in the body. Further studies on auto-antigens of the anti-CCP antibodies in non-RA CTD patients are warranted. The present study was supported in part by JSPS KAKENHI (grant no. Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Causes of MSK pain are divided into nonrheumatic and rheumatic categories. Antinuclear Antibodies (ANA) Test: Results, Positive vs - WebMD Group 1 consists of patients who fulfilled the 1987 revised American College of Rheumatology (ACR) criteria of RA before the anti-CCP antibody test was performed, group 2 consists of patients who fulfilled the 1987 ACR criteria in the follow-up period, and group 3 consists of patients never fulfilled the 1987 ACR criteria. Arthritis Rheum. Anti-citrullinated peptide antibody assays and their role in the diagnosis of rheumatoid arthritis. TI and SN measured anti-CCP antibody titers by ELISA. We speculated that the anti-CCP antibody in non-RA CTD patients was not genuine ACPA, but a citrullination-independent antibody. In both patients with primary and SLE associated APS positive results correlate with a predisposition for arterial or venous thrombosis, foetal loss, or thrombocytopoenia. The reaction between enzyme and substrate is stopped and color in the wells is measured in a microtiter plate reader. Arthritis Rheum. However, some non-RA connective tissue disease (CTD) patients also test positive for the anti-CCP antibody and, thus, may ultimately develop RA. 1) (Table3). In comparisons of characteristics between anti-CCP-positive non-RA CTD patients and RA-overlapping CTD patients, the Mann-Whitney U test was used for continuous variables and Fishers exact test for categorical variables. The anti-CCP antibodies can exist in a person's system long before they ever exhibit symptoms of RA. Tasliyurt T, Kisacik B, Kaya SU, Yildirim B, Pehlivan Y, Kutluturk F, et al. RACGP - Antinuclear antibody test - Australian Family Physician On the other hand, 33 out of 780 non-RA CTD patients (4.2%) tested positive for the anti-CCP antibody. A positive result by itself does not automatically lead to a diagnosis. 2a). The present study was performed in accordance with the Helsinki Declaration and was approved by Kyoto University Graduate School and Faculty of Medicine Ethics Committee (approval numbers: E458 and R1540). Testing is performed on the Agility instrument by Dynex. The Mann-Whitney U test was used to analyze absorbance difference between anti-CCP and anti-CAP patients. Rheumatoid arthritis (RA) is a chronic, systemic inflammatory . The frequency of the HLA-DRB1 shared epitope (SE) and anti-CCP antibody titers were both significantly higher in anti-CCP-positive RA-overlapping CTD patients than in anti-CCP-positive non-RA CTD patients, while no significant differences were observed in citrullination dependency. The 1987 revised ACR criteria were used to diagnose RA; therefore, the potential effect of anti-CCP positivity on the RA or non-RA classification was excluded. The entire, 55-min procedure for the detection of RF and anti-CCP using a dual-target ELISA assay is shown schematically in Fig. Antirheumatic therapy should not be initiated based solely on a positive test for CCP antibodies, and changes in treatment should not be based upon the levels of CCP antibodies. 7 Anti-CCP antibodies and anticitrullinated filaggrin antibodies are . 2009;36(12):268290. 2008;1143:26885. However, the anti-CCP antibody test is the most widely-used ACPA test in clinical practice due to its accuracy [5]. The normal level of anti-CCP antibodies is less than 20 units/mL. Significant threshold was set to p=0.05. Arthritis Res Ther 22, 248 (2020). Our science team is put through the strictest vetting process in the health industry and we often reject applicants who have written articles for many of the largest health websites that are deemed trustworthy. A positive anti-CCP and negative RF blood test show that you may be in the early stages of the disease or may have it in the future. Aletaha D, Neogi T, Silman AJ, et al: 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Antirheumatic therapy should not be initiated based solely on a positive test for CCP antibodies, and changes in treatment should not be based upon the levels of CCP . Ann Rheum Dis. Since some patients in the database were diagnosed with overlapping RA, the attending physicians of patients diagnosed with RA completed a questionnaire survey in January 2020 to confirm whether their patients fulfilled the 1987 revised American College of Rheumatology (ACR) criteria for the classification of RA [25]. The present results revealed that anti-CCP-positive non-RA CTD patients rarely developed RA. Thus, the presence of anti-CCP Abs must be interpreted as highly suggestive of a diagnosis of EORA. For more information see Connective Tissue Disease Cascade. Arthritis Rheum. Anti-cyclic Citrullinated Peptide (Anti-CCP) Antibodies . Although all 60 samples tested positive for the anti-CCP antibody using a commercial ELISA kit, 5 out of 33 RA-overlapping CTD and 6 out of 27 non-RA CTD serum samples tested negative using our in-house CCP ELISA. We believe that the most accurate information is found directly in the scientific source. The false-positive rate of anti-CCP is difficult to come by. Hedstrom AK, Ronnelid J, Klareskog L, Alfredsson L: Complex relationships of smoking, HLA-DRB1 genes, and serologic profiles in patients with early rheumatoid arthritis: Update from a Swedish population-based case-control study. 01. Rheumatology Labs 101 | Hospital Handbook Arthritis Rheum. HLA-DRB1 SE and anti-CCP antibody titers may facilitate the differentiation of RA-overlapping CTD from anti-CCP-positive non-RA CTD. Understanding Rheumatoid Arthritis Lab Test Results | HSS You might be able to help lower your inflammatory joint symptoms by maintaining adequate vitamin D levels, addressing any gum disease you may have, and quitting smoking. The aim of this study was to evaluate the specificity of SARS-Cov-2 serological assays using . 1). The datasets generated and/or analyzed in the present study are available from the corresponding author upon reasonable request. Shiboski SC, Shiboski CH, Criswell L, Baer A, Challacombe S, Lanfranchi H, et al. We also investigated the citrullination dependency of anti-CCP test results because anti-CCP antibodies may react with the non-citrullinated part of CCP peptides, which have been reported in several diseases, such as SLE [16], autoimmune hepatitis [14], and tuberculosis [15]. (3-5) To facilitate early diagnosis, the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria recommend testing for rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA). Takeshi Iwasaki and Shuichiro Nakabo contributed equally to this work.

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