Tedesco A, D'Agostino D, Soriente I, Amato P, Piccoli R, Sabatini P
UOC di Patologia Clinica, D.E.A.II Umberto I, Nocera Inferiore, A.S.L.Salerno1, Italy; Dipartimento di Biologia Strutturale e Funzionale, Università di Napoli Federico II, via Cinthia, Napoli 80126, Italy.
Autoimmun Rev. 2009 Jan;8(3):233-7. doi: 10.1016/j.autrev.2008.07.031. Epub 2008 Aug 15.
Rheumatoid arthritis [RA] is one of the most common and severe autoimmune rheumatic diseases, diagnosed primarily according to clinical manifestations and radiological reports. For many years, laboratory diagnosis of rheumatoid arthritis has relied on the detection of rheumatoid factor [RF], as established by the ACR criteria. A recent test to detect antibodies towards citrullinated peptides, called the anti-CCP assay, showed a similar sensitivity but a more elevated specificity than the RF test. Our intention was the recognition of an optimal diagnostic strategy that exhibits the highest sensitivity and specificity for RA detection. To this purpose, we examine the usefulness of autoantibodies in RA testing, evaluating the diagnostic performance of conventional and innovative assays for RF detection, and ELISA anti-CCP test, for anti-CCP antibodies detection, by a prospective study. Multiplex cytofluorimetric test appeared to be more sensitive and specific than nephelometric assay for RF detection. Hence, a novel combined approach, significantly increasing the diagnostic sensitivity for RA, was planned, employing the multiplex RF test in combination with the anti-CCP test.
类风湿关节炎（RA）是最常见且严重的自身免疫性风湿疾病之一，主要依据临床表现和影像学报告进行诊断。多年来，类风湿关节炎的实验室诊断一直依赖于美国风湿病学会（ACR）标准所确立的类风湿因子（RF）检测。最近一种检测瓜氨酸化肽抗体的试验，即抗环瓜氨酸肽（CCP）检测，显示出与RF检测相似的敏感性，但特异性更高。我们的目的是识别一种对RA检测具有最高敏感性和特异性的最佳诊断策略。为此，我们通过一项前瞻性研究，考察自身抗体在RA检测中的效用，评估用于检测RF的传统和创新检测方法以及用于检测抗CCP抗体的ELISA抗CCP检测的诊断性能。对于RF检测，多重细胞荧光检测似乎比散射比浊法更敏感、更具特异性。因此，计划采用一种新的联合方法，即将多重RF检测与抗CCP检测相结合，显著提高RA的诊断敏感性。
