Anti-CCP blood test. What is it the norm in rheumatoid arthritis, ankylosing spondylitis in women, men over the age of, the table. Decoding results that shows Hemotest invitro

Analysis of blood CCPA - a highly specialized clinical test to identify rheumatoid arthritis. Application study provides an opportunity to discover the violation at an early stage, when completely no clinical symptoms of joint disease. Also, such an analysis is indispensable to evaluate the course of inflammation has been identified and adjustments prescribed therapy.

What is the ACCP blood analysis

CCPA blood-analysis - it is a study that reveals the presence in the blood of antibodies to cyclic citrullinated peptide (CCP). Normally, this peptide (peptides structurally similar to the protein, but have a lower molecular weight, they can be conditionally called "lightweight" proteins) necessary for normal operation of the articular tissues, and must not contain amino acid citrulline.

However, if the body started atypical processes (physiological or induced illness), joint shell begins to secrete a protein CCP (containing citrulline). In response, the human immune system perceives unusual peptide as "pathogenic" and "attacks" it, producing specific antibodies (anti-CCP).

This "attack" is accompanied by inflammation and thickening of the synovial membrane.

So begins an autoimmune process which affects the connective tissue, mainly the small joints - rheumatoid arthritis. Anti-CCP test enables to detect the process at an early stage - at a time when the development of antibodies has not yet lead to any changes in articular.

In addition, the survey accurately determine the concentration of antibodies in the patient's blood sample - this figure makes it possible to forecast the flow of an autoimmune disorder.

What diseases can be determined using anti-CCP

CCPA blood analysis - this is a specialized research, the purpose of which is to confirm a diagnosis - rheumatoid arthritis. However, in some cases it may indirectly serve to identify other joint disorders, symptoms which is similar to rheumatoid arthritis. If the blood sample does not confirm arthritis - cause must be sought among other diseases.

Need to analyze

Blood for anti-CCP should be carried in the presence of absolute indications or appearance characteristic symptoms.

Among the latest release:

• pain and swelling in small joints (foot and brush) - if these manifestations stably present for 2 months;
• morning stiffness, the appearance and dimensions of the joints are not changed;
• pain in the knee and elbow joints, and the joints connecting the wrist with the forearm and lower leg with the foot - if the symptom is not accompanied by an infection.

In addition, the analysis should take the people who are close relatives who suffer from rheumatoid arthritis. In such cases, a study should be carried out regularly throughout life.

Advantages and disadvantages of the method

CCPA (blood test) - it is a study which could be called the "gold standard" for detection of rheumatoid arthritis. CCPA actively competes with the more "old" kind of diagnosis - rheumatoid factor.

The main pros and cons of anti-CCP are shown in the table below:

Criteria of evaluation	Deciphering the criteria for the analysis of anti-CCP	Advantages and disadvantages
Sensitivity - the ability of a sample to identify the disease.	It evaluated based on the number of false negative results, averages 70%	+
The sensitivity at the early stage	For anti-CCP, the figure is 50% in pervye6 months revmo factor is detected in 35% of patients in the first 12 months	+
Specificity	Estimated on the basis of how often the antibodies found in people with rheumatoid arthritis. For CCPA figure reaches 98%	+
Probability negative test in the presence of rheumatoid arthritis	15% of people with rheumatoid arthritis anti-CCP can deny the disease throughout their lives or be delayed. For this rheumatoid factor is greater than 50%	+
The probability of a positive anti-CCP in the absence of rheumatoid arthritis	False positive anti-CCP assay can only take place in systemic lupus erythematosus (according to official studies). Revmo false-positive factor is the case in 40% of men and 5% of them are completely healthy	+
Possible to assess the dynamics of the disease	Increasing concentrations of anti-CCP may serve to assess the progress of disease or efficacy of treatment. Changing the numerical value of rheumatoid factor of any clinical significance has not	+
speed survey	Result of the analysis on antibodies to CCP can be obtained after 2-3 days. Blood test for revmo factor will take 1-2 days	+
cost of	Examination approximately 3 times more expensive in comparison with revmo factor	—
Availability	Analysis can be performed in private diagnostic laboratories. The state of his clinic, as a rule, do not spend	—

It was the last two factors (availability and price) is due to the prevalence of the diagnosis of rheumatoid factor analysis.

Indications for depositing anti-CCP assay

CCPA blood-analysis - it is a study that is not appointed without objective reasons.

Among the absolute indications for a sample:

• cheirarthritis in the absence of violations on the X-ray image;
• identification on the X-ray inspection of the cysts in periarticular areas;
• the need to predict the risk of rheumatoid arthritis within 1-2 years before the appearance of symptoms step - assuming a hereditary predisposition;
• assumption of the presence of rheumatoid arthritis - is based on the results of other biochemical samples (especially rheumatoid factor);
• evaluation of presence of antibodies in the early (up to six months) and the first (6 months to 1 year) stage of the disease;
• identify forms of arthritis, seronegative - species in which symptomatology is present, and rheumatoid factor denies disease;
• differentiation from rheumatoid arthritis similar clinical signs of the disease;
• determination of the dynamics of the process of destruction of the joints - carried out, based on the quantification of antibody concentration;
• evaluation of the effectiveness of therapy to a patient assigned - during a previous diagnosis;
• presence of diseases involving lesions of the connective tissue in close relatives;
• clinically identified genetic predisposition to autoimmune disorders.

CCPA is invaluable in the therapy of rheumatoid arthritis - test (this is one of the key differences CCPA from revmo factor) gives to predict a more aggressive course of the disease and rate, respectively, to adjust in advance treatment.

Preparation for the analysis of anti-CCP

Preparatory measures preceding analysis, differ slightly from the majority of biochemical blood tests.

The most reliable results ensure adherence to this algorithm:

1. 5 days prior to sampling of biological material should stop taking any medication (except for essential medicines).
2. For 3 days, it is desirable to exclude from the menu fatty and salty foods, fried foods, sugar, alcohol.
3. If possible, should not smoke for 24 hours prior to analysis (in the extreme case, should refrain from smoking for 4 hours before delivery).
4. The last meal should be 12 (optimal) or 4 hours (if the blood is delivered in the daytime hours) prior to the study.
5. In the morning you can drink only water. Tea, coffee and juices should be abandoned. If blood sampling is carried out during the day, these drinks can be excluded for 4 hours.
6. Within 4-6 h before delivery it is desirable to eliminate physical stress.

Assay procedure

The material for the study is the venous blood. For serum biomaterial being processed in a centrifuge.

To detect antibody concentrations used method 3:

• immunofluorescence - Treatment of the desired antibodies, followed by a fluorescent substance study the serum sample under a microscope;
• chemiluminescent - highlighting antibodies under the influence of chemical compounds;
• linked immunosorbent assay test using 2nd generation - is considered preferable, the registration is simple and stable compounds "desired antibody-enzyme". It provides as qualitative (antibodies are present / absent) or quantitative analysis.

non-urgent test results can be obtained after 1-3 days, urgent - a few hours after taking the biomaterial.

Transcription analysis CCPA

Normal values ​​or intervals will depend on the lab, the equipment used and the method of serum studies.

If you are using immunofluorescence technique, such values ​​may appear in the form of the results:

• less than 3 units / ml - "negative result;
• less than 5 units / ml - "weak positive" result;
• 5 U / ml or more - further studies are needed.

If the analysis is carried out by means of chemiluminescence, the threshold value will be 17 units / ml.

When using enzyme-linked immunosorbent assay ( "gold standard" upon detection of anti-CCP) you can navigate to these reference indicators:

• 30 RU / ml - antibodies are not detectable, "negative" result;
• from 30 to 90 RU / ml - low concentration of antibodies "weak positive" result. In this case, it makes sense to repeat the study in a month;
• 90 RU / ml - significant concentrations of antibodies, the "positive" result.

Results of the analysis can not be used for self-diagnosis. Speak about the presence / absence of the disease can be based on the overall picture, including symptoms, data on heredity and other studies.

General provisions are given in the table below:

results of the analysis	symptomatology	Other studies (rheumatoid factor spondylitis marker)	Forecast
Negative	Absent	It does not play a decisive role	The risk of developing the disease is small, but if the process starts, it will take place in an easy manner
Positive	present	Rheumatoid factor can be either positive or negative	Development of the disease is likely, or it occurs at an early stage
Positive antibodies high concentration	Present corresponds clinic rheumatoid arthritis	Rheumatoid factor positive	The process is developing rapidly, may cause severe symptoms

The table shows only general cases. In real life, objectively assessed symptoms, the presence of genetically caused diseases, including joint (e.g., ankylosing spondylitis - ankylosing spondylitis, wherein the joints are destroyed and the sacrum spine).

inaccuracies analysis

CCPA blood analysis can not be the only study in the diagnosis of "rheumatoid arthritis". Sensitivity and specificity of the test is not 100%.

In addition, these patterns can be identified among the inaccuracies:

• sensitivity (the reciprocal of the number of false negative results) increases as the disease progresses. The longer the process takes place, the greater the likelihood that the study will identify antibodies;
• CCPA may not be detected with active rheumatoid arthritis flowing - this situation occurs in 15% of patients. Of these, part of it is found later, the rest - are not detected at all. it is often associated with the presence of inflammation associated vessels or the bones;
• result may be false-positive (confirmed by clinical studies) in systemic lupus erythematosus - in rare cases.

There is evidence of false positive test results in the anti-CCP in people suffering from:

• impaired liver function, including cirrhosis;
• cancer;
• Tuberculosis in the severe form.

Where can I get tested

Blood Test for anti-CCP can be taken in private clinics or large laboratories, with branches throughout Russia. When choosing a medical facility, you should pay attention not only on cost but also on the method of detection of antibodies. No less important is the presence of a wide variety of laboratory tests performed - it indicates the presence of the necessary equipment.

In this procedure may be different even in different branches of a network of laboratories.

The average cost of analysis is from 1000 to 1500 rubles. In the prestigious clinic price can reach 3000 rubles. If you need an urgent analysis, the cost increases.

What treatment is given at higher values ​​ACCP

If the analysis on the ACCP and other research (ESR blood revmo factor) confirm the presence of the disease, as well as the present symptoms, diagnosed "rheumatoid arthritis" one of the 4 classes. The class depends on whether the patient is preserved performance. Techniques can cure the disease completely, it does not exist today.

Combined therapy will focus on:

• elimination of symptoms;
• Warning deforming changes in the joints;
• normalizing motility articular joints;
• increase remission periods (attenuation of symptoms of the disease);
• improving the quality and increasing the life expectancy of the patient.

Treatment involves 4 areas:

• taking medication - is the basis of therapeutic tactics;
• physiotherapy - used individually tailored exercise facilities;
• physiotherapy (Magnetic, ultrasound, electrophoresis) - are used to: reduce inflammation, swelling and pain; normalization of blood circulation in the joints; stimulation of tissue repair; increasing the effectiveness of the medication;
• traditional medicines - after consulting a doctor is able to successfully complement traditional therapy.

Drug therapy involves 2 directions. Basic antirheumatic drugs - affect the course of the underlying disease.

The number of groups of medications include:

• immunosuppressants (Methotrexate, cyclophosphamide, leflunomide) - suppresses the immune system, "wrong" and the operation of which causes inflammation. The drugs are highly effective, can reduce the need for painkillers;
• sulfonamides (Salazopiridozin, sulfasalazine) - attenuate the symptoms of disease, reduce the production of antibodies. Preparations are well tolerated, produce results after a long time - from 3 months to 1 year;
• aminohinolinovogo (Antimalarial) drugs (Rezohin, hydroxychloroquine) - suppress immunity and reduce inflammation in autoimmune diseases;
• gold salts (Aurothiomalate, Auronofin) - suppress erosive changes in the joints and reduces the concentration of antibody. Additionally, the drug has a bracing effect. Medications have a number of specific side effects;
• genetically modified products (Embrel, Lorentz, Rituxan, Humira) - alter immune response by selectively acting on the dates of enzymes. The disadvantages is the growth probabilities secondary infection and exacerbation of chronic disorders. Biological agents conventionally referred to as the basic therapy, most often they are used with the ineffectiveness of immunosuppressants and sulfonamides. Their technique helps reduce the risk of cardiovascular disorders that accompany rheumatoid arthritis.

Means of symptomatic therapy - drugs that eliminate pain and inflammation without affecting the underlying disease. Among the groups of drugs: nonsteroidal anti-inflammatory drugs - NSAIDs (ibuprofen, indomethacin, Ketanov) and corticosteroids (prednisolone, dexamethasone). Glucocorticosteroids have more side effects, however, allow you to instantly remove strong pain.

During the selection means basic therapy drugs that do not give effect for 1.5-3 months, change to other means or combinations thereof.

In this case, the optimal period of selection of therapy should not exceed six months. Patients who are prescribed treatment regimen should carefully monitor the condition of the joints and the body as a whole, keeping track of all changes and possible side effects.

Among the popular folk remedies:

• potatoes with yogurt. A small tuber need grate and pour yogurt (100 mL). Should take in the morning, before you eat 10 consecutive days, followed by 10 days in a day, then 10 days in 2 days. At each meal mixture should prepare a new mixture;
• buttercup flowers. 30 pieces should grind pestle. When the flowers will give juice, you need to put weight on a layer of gauze, and then attach to the sore joint. Compress duration - 2 hours;
• mixture radish juice, honey and alcohol. 200-300 ml (1.5 cups) of black radish juice, 70 ml of honey (cup part) and 50 ml of vodka should be mixed until a homogeneous mass. Apply topically means necessary, rubbing the affected joint by 3 times a day.

Treatment of rheumatoid arthritis - a lengthy process, requiring patience and observing compliance rheumatologist and receiving circuits preparations and physical therapy. CCPA blood analysis today is a highly specific marker of the disease.

Implementation of this research allows to predict the development of the disease in 1-2 yearsAnd to identify the disease at an early stage, when there are no changes in the tissues of the joints.

Apart from this analysis may be used during the treatment - for objective assessment correct selection of basic drugs. CCPA marker makes it possible to assign therapy, allowing to increase the duration and improve the quality of life of the patient.

Useful video about anti-CCP blood test and its rules

Anti-CCP test for the diagnosis of rheumatoid arthritis:

As developing rheumatoid arthritis: