Original Research Article DOI: 10.18231/2455-6807.2017.0033 International Journal of Medical Microbiology and Tropical Diseases, October-December 2017;3(4):137-139 137 RF and Anti-CCP Antibody Tests- A comparative study in the Diagnosis of Rheumatoid Arthritis in a Tertiary Care Hospital Ashwini Kacharu Dedwal 1 , Ankita Anand 2,* , Sae Satish Pol 3 , Renu Satish Bharadwaj 4 1, 2 Assistant Professor, 3 Associate Professor, 4 Professor & Head, Dept. of Microbiology, B.J. Govt. Medical College, Pune *Corresponding Author: Email: drankita.anand27@gmail.com Abstract Introduction: Rheumatoid arthritis (RA) is autoimmune disease associated with chronic inflammation of joints causing deformities and functional impairment. Diagnosis primarily depends on clinical manifestations because of lack of suitable diagnostic tests. Rheumatoid factor (RF) is an autoantibody specific for Fc portion of human IgG. RF has low specificity as high false positive results are common in general population. Anti CCP antibody is also useful marker to diagnose rheumatoid arthritis and included in one of the criteria of American College of Rheumatology (ACR) /European League against Rheumatism (EULAR) classification of RA. Thus the present study was planned to compare the diagnostic utility of RF and Anti CCP antibody test in Rheumatoid arthritis patients in a Tertiary Care Hospital. Aim & Objective: To compare the diagnostic utility of RF and Anti CCP antibody test in Rheumatoid arthritis patients. Material & Methods: A total of 72 samples were taken from clinically suspected RA patients over a period of 3 months. RF was determined by latex agglutination method (STAR DIAGNOSTICS) and Anti CCP antibody by ELISA (IMTEC ANTI CCP ANTIBODIES ELISA- GERMANY). The tests were performed as per manufacturer’s instructions. Results & Discussion: Out of total 72 samples tested, 47(58.33%) were positive. Both RF and Anti CCP Antibody was positive in 9 cases. Only RF positivity was seen in 8 cases and only Anti CCP antibody was positive in 30 cases. In present study combination of Anti CCP antibody and Rheumatoid factor together have shown positive predictive value for Rheumatoid Arthritis patients which lack specific signs and symptoms related to diagnosis of RA Conclusion: Anti CCP antibody test and RF can be used concomitantly to diagnose Rheumatoid arthritis and can be used in clinical settings so that appropriate management can be initiated to decrease future morbidity. Keywords: Anti CCP, RF, ELISA, RA. Introduction Rheumatoid arthritis (RA) is a common disease with prevalence rate 1% worldwide and more common in women than men. (1) RA is autoimmune disease with unknown etiology manifesting with chronic inflammation of joints and production of several auto antibodies leading to joint destruction, deformities and functional impairment, disability. (2,3) In RA disease auto antibodies are produces such as rheumatoid factor (RF), anti-perinuclear factor (APF), ANCA, anti-RA33, anti- flaggerin anti-bodies, anti-keratin antibodies (AKA), anti-cyclic citrullinated peptide antibodies (CCP), etc. (4) Among the various auto antibodies, RF and anti-CCP antibodies are considered useful serological diagnostic markers for RA. (3) Rheumatoid factor (RF) is IgM autoantibody directed against the Fc portion of IgG. Anti-cyclic Citrullinated peptide antibody (Anti-ccp) is autoantibody that is formed after Citrullination. (3,5) For serological diagnosis of RA routinely serum RF determination have high sensitivity, with low specificity, particularly in the early course of the disease. (6) Anti-CCP auto antibodies are recently used for diagnosis of RA and is useful to predict the severity of the disease. (7) Anti-CCPs has been recently added as one of the criteria in the American College of Rheumatology (ACR) /European League against Rheumatism (EULAR) classification of RA. (8) Some studies have shown that Anti- CCP antibodies have moderate sensitivity and high specificity for diagnosis of RA, when compared with RF. (9) Diagnosis of RA primarily depends on clinical manifestations because of lack of suitable diagnostic tests. Although RF and X-ray imaging have important diagnostic value, there is no specific biomarker for the diagnosis of RA at present but anti-CCP antibody detection could improve the specificity of RA diagnosis. Thus the present study was planned to compare the diagnostic utility of RF and Anti CCP antibody test in Rheumatoid arthritis patients in a Tertiary Care Hospital. Materials & Methods This was a prospective laboratory based study. Inclusion criteria: a total of 72 samples from clinically suspected RA patients over a period of 3 months between 20 and 60 years of age from both genders were included in this study. Exclusion criteria: Patients of chronic renal failure, malignancy, diabetes mellitus, HIV, HBV and HCV, and pregnant women. RF was determined by latex agglutination method (STAR DIAGNOSTICS) and Anti CCP antibody was detected by ELISA (IMTEC ANTI CCP ANTIBODIES ELISA-GERMANY). The tests were performed as per manufacturer’s instructions.