Diagnostic Accuracies of Anti-cyclic Citrullinated Peptide Antibody and Rheumatoid Factor in Korean Patients with Rheumatoid Arthritis: A Meta-analysis

Young Ho Lee; Jin Hyun Woo; Seong Jae Choi; Jong Dae Ji; Gwan Gyu Song

doi:10.4078/jkra.2008.15.1.27

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Lee, Woo, Choi, Ji, and Song: Diagnostic Accuracies of Anti-cyclic Citrullinated Peptide Antibody and Rheumatoid Factor in Korean Patients with Rheumatoid Arthritis: A Meta-analysis

Original Article

J Korean Rheum Assoc 2008;15(1):27-38.

Published online: 20 March 2008

DOI: https://doi.org/10.4078/jkra.2008.15.1.27

Diagnostic Accuracies of Anti-cyclic Citrullinated Peptide Antibody and Rheumatoid Factor in Korean Patients with Rheumatoid Arthritis: A Meta-analysis

Young Ho Lee, M.D., Jin Hyun Woo, M.D., Seong Jae Choi, M.D., Jong Dae Ji, M.D., Gwan Gyu Song, M.D.

Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

Received 28 December 2007 Accepted 21 February 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: Rheumatoid arthritis, Anti-CCP, RF, Meta-analysis

References

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Fig. 1.

Flow diagram of study selection. Articles reported the diagnostic value of anti-CCP antibody and RF testings for RA.

Fig. 2.

Sensitivity (A) and specificity (B) estimates for anti-CCP antibody for the diagnosis of RA. Circles and lines represent point estimates and 95% CIs, respectively. Circle areas represent relative study sizes. 1 means 100% in sensitivity and specificity.

Fig. 3.

SROC curves for anti-CCP antibody (A) and for RF (B) for the diagnosis of RA Solid circles represent individual studies included in this meta-analysis. The curve shown is a regression line that summarizes overall diagnostic accuracy. SE (AUC), standard error of AUC, Q∗, an index defined by the point on the SROC curve where the sensitivity and specificity are equal; SE (Q∗), Q∗ index standard error.

Fig. 4.

SROC curves for either anti-CCP or RF (A) and both anti-CCP and RF positivity (B) for the diagnosis of RA Solid circles represent individual studies included in this meta-analysis. The curve shown is a regression line that summarizes overall diagnostic accuracy. SE (AUC), standard error of AUC, Q∗, an index defined by the point on the SROC curve where the sensitivity and specificity are equal; SE (Q∗), Q∗ index standard error.

Table 1.

Characteristics of individual studies included in meta-analysis

Author	Year	Numbers		Mean age, yrs (range)		Female (%)		Anti-CCP		RF
Author	Year	RA	Control	RA	Control	RA	Control	Sensitivity^∗	Specificity^∗	Sensitivity^∗	Specificity
Song et al	2007	48	OA 50	52.2	51.0	89.6	86	0.896(0.773∼0.965)	0.960 (0.863∼0.995)	0.771 (0.627∼0.880)	0.880 (0.757∼0.99
Park et al	2007	262	NRA 122	NA	NA	80.9	73.8	0.809(0.756∼0.855)	0.910 (0.844∼0.954)	0.908 (0.867∼0.940)	0.721 (0.633∼0.79
Kim et al	2006	114	NRA 202	51.1 (23∼80)	NA	83.3	NA	0.675(0.581∼0.760)	0.960 (0.923∼0.983)	0.658 (0.563∼0.744)	0.847 (0.789∼0.89
Choi et al	2005	324	NRA/HC 251/28	51 (22∼83)	53.4 (4∼90)/ 50.4 (1∼72)	84.9	83.7/ 53.8	0.728 (0.676∼0.776)	0.957 (0.936∼0.973)	0.806 (0.758∼0.847)	0.821 (0.786∼0.85
Kim et al	2005	110	NRA/HC 30/46	50.0 (17∼78)	NA	81.8	NA	0.800(0.713∼0.870)	0.947 (0.871∼0.985)	0.718 (0.624∼0.800)	0.829 (0.725∼0.90
Kim H et al	R 2005	49	NRA/HC 104/51	NA	NA	NA	NA	0.816(0.680∼0.912)	0.955 (0.909∼0.982)	0.964 (0.546∼0.817)	0.755 (0.679∼0.82
Kang et al	2003	134	NRA/HC 53/33	NA	NA	NA	NA	0.761(0.680∼0.831)	0.942 (0.870∼0.981)	0.672 (0.585∼0.750)	0.744 (0.639∼0.83
Total		1,041	970

RA: rheumatoid arthritis, OA: osteoarthritis, NRA: non-RA rheumatic diseases, HC: healthy control, NA: not available

^∗ 1 means 100% in sensitivity and specificity

Table 2.

Summary results of meta-analysis in RA vs. NRA

(A)
Antibody	Comparison		Study No.	Sensitivity^∗	Specificity^∗	PLR	NLR	DOR
Anti-CCP	RA vs NRA		7	0.767(0.740∼0.792)	0.951 (0.938∼0.963)	14.837 (11.567∼19.031)	0.244 (0.202∼0.294)	59.235 (43.806∼80.097)
RF	RA vs NRA		7	0.782(0.756∼0.807)	0.805 (0.781∼0.826)	3.687 (3.027∼4.492)	0.298 (0.218∼0.406)	12.915 (8.427∼19.771)
Anti-CCP or RF	RA vs NRA		3	0.852 (0.818∼0.882)	0.745 (0.703∼0.784)	3.374 (2.868∼3.970)	0.197 (0.158∼0.245)	17.565 (12.462∼24.758)
Anti-CCP and RF	RA vs NRA		3	0.794 (0.752∼0.832)	0.965 (0.944∼0.980)	22.230 (13.727∼36.001)	0.212 (0.056∼0.810)	158.46 (52.804∼475.54)
RA: rheumatoid arthritis, NRA: non-RA rheumatic diseases, HC: healthy control, PLR: positive likelihood ratio, NLR: negative likelihood ratio, DOR: diagnostic OR
^∗: 1 means 100% in sensitivity and specificity
(B)
Antibody		Comparison		Study No.	AUC	SE (AUC)	Q^∗	SE (Q^∗)
Anti-CCP		RA vs NRA		7	0.9453	0.0204	0.8842	0.0266
RF		RA vs NRA		7	0.8583	0.0179	0.7891	0.0172
Anti-CCP or RF		RA vs NRA		3	0.8593	0.0799	0.7901	0.0770
Anti-CCP and RF		RA vs NRA		3	0.9864	0.0102	0.9501	0.0102

NRA: non-RA rheumatic diseases, AUC: area under the curve, SE: standard error

Table 3.

Summary results of meta-analysis in RA vs. HC

(A)
Antibody	Comparison	Study No.	Sensitivity^∗	Specificity^∗	PLR	NLR	DO
Anti-CCP	RA vs NRA	4	0.755(0.719∼0.789)	0.988 (0.972∼0.996)	52.791 (23.009∼121.12)	0.252 (0.218∼0.290)	217.14 (91.287∼516.49)
RF	RA vs NRA	3	0.757(0.720∼0.792)	0.847 (0.805∼0.882)	4.715 (1.737∼12.802)	0.321 (0.201∼0.514)	15.714 (3.596∼68.666)
RA: rheumatoid arthritis, NRA: non-RA rheumatic diseases, HC: healthy control, PLR: positive likelihood ratio, NLR: negative likelihood ratio, DOR: diagnostic OR
^∗: 1 means 100% in sensitivity and specificity
(B)
Antibody	Comparison		Study No.	AUC	SE (AUC)	Q^∗	SE (Q^∗)
Anti-CCP	RA vs HC		4	0.9382	0.1089	0.8752	0.1365
RF	RA vs HC		3	0.8042	0.0868	0.7396	0.0763

HC: healthy control, AUC: area under the curve, SE: standard error

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