What does a high Cyclic Citrullinated Peptide (CCP) level indicate?

From the Guidelines

A high Cyclic Citrullinated Peptide (CCP) level is a strong indicator of rheumatoid arthritis (RA), with high specificity (90%) for the disease, as noted in the study published in the Mayo Clinic Proceedings 1.

Key Points to Consider

• The CCP antibody test is highly specific for RA, meaning that elevated levels are rarely found in people without the disease.
• CCP antibodies can appear years before symptoms develop, making this test valuable for early diagnosis.
• The higher the CCP level, the more likely the patient has RA and may experience a more aggressive disease course with greater joint damage.
• Patients with high CCP levels often require prompt treatment with disease-modifying antirheumatic drugs (DMARDs) to prevent joint destruction.

Diagnosis and Treatment

• A positive CCP result combined with symptoms and other tests like rheumatoid factor helps confirm the diagnosis and guides treatment decisions.
• The study emphasizes the importance of early referral and diagnosis, as well as aggressive treatment modification to achieve targets based on a composite disease activity score, such as the Disease Activity Score using 28 joint counts (DAS28) 1.
• The use of composite measures, such as the Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI), can provide a more stringent definition of disease activity and guide treatment decisions.

Clinical Implications

• The presence of high CCP levels should prompt clinicians to consider a diagnosis of RA and initiate appropriate treatment to prevent long-term joint damage and improve patient outcomes.
• The study highlights the importance of routine evaluation, including assessment of patient-reported outcomes, physical examination, and laboratory tests, to monitor disease activity and adjust treatment accordingly 1.

From the Research

Cyclic Citrullinated Peptide (CCP) Levels

• A high Cyclic Citrullinated Peptide (CCP) level is associated with an increased risk of developing rheumatoid arthritis (RA) [ 2, 3 ].
• Studies have shown that the risk of progression to RA increases with higher CCP antibody levels [ 3 ].
• Patients with high-level CCP antibodies are more likely to progress to RA, with 46.0% progressing to RA by 5 years [ 3 ].

CCP Antibody Levels and RA Progression

• CCP antibody levels can be classified as low, medium, or high, with high levels being associated with a greater risk of RA progression [ 3 ].
• Medium and high CCP antibody levels are strongly associated with progression to RA, with hazard ratios of 3.00 and 4.83, respectively [ 3 ].
• The risk of RA progression increases substantially with increasing CCP antibody level, highlighting the importance of close monitoring for RA development in CCP-positive patients [ 3 ].

Clinical Significance of High CCP Levels

• High CCP levels can indicate a higher risk of RA development and progression [ 2, 3 ].
• The presence of anti-CCP antibodies, at both low and high concentration, is significantly associated with RA development in subjects with recent onset undifferentiated arthritis [ 2 ].
• Time to RA diagnosis is shorter in patients with high anti-CCP2 titers at enrollment [ 2 ].