Whether the estimation of C-reactive protein is enough to predict inflammation and its intensity. What's the role of Anti CCP or RF. Is there any correlation between these three?
CRP is a marker of inflammation and has some correlation with disease activity. DAS28 is a clinical score for disease activity and either CRP or the ESR is included as a component of the score. I'm not aware of anti-CCP or RF being linked to disease activity (although the titre can drop with treatment).
A. About Rheumatoid Factor (RF) and Anti-CCP:
RF and anti-CCP are diagnostic markers of rheumatoid arthritis, not indices of inflammatory activity.
RF can be positive in healthy persons, and positivity in healthy persons increases with age.
Anti-CCP assays are very useful in the diagnosis of rheumatoid arthritis, especially during the early phases of the disease.
Anti-CCP have also a predictive value: They may accurately predict the likelihood of developing rheumatoid arthritis (RA) in patients with recent-onset undifferentiated arthritis.
B. About CRP and ESR:
ESR and CRP are acute phase reactants, i.e. non-specific markers of inflammatory activity.
ESR and CRP levels may be elevated in a number of inflammatory conditions.
Acute-phase tests are also moderately useful in distinguishing inflammatory from non-inflammatory arthritis and in monitoring the course of an inflammatory disease such as rheumatoid arthritis.
CRP increases more rapidly than the ESR, which may take several days to increase. Concentrations of C-reactive protein (CRP) increase as much as 100-fold within 1 or 2 days.
Majda Khoury - Thanks for the info. Is there any relation between the anti - CCP and cartilage degradation/degeneration. I would like to know ...from where the Anti -CCP is produced (in tissue/blood cells) and whats the target for this antibody? How the stages of disease in arthritis is assessed?
1. Anti-CCP are auto-antibodies produced by B lymphocytes, present in large numbers in the inflamed synovium. They are against citrullinated peptides (formed by conversion of arginine to citrullin). RF is an autoantibody usually of the IgM class against the Fc portion of the normal IgG.
2. Anti-CCP ( as well as RF) do not target the cartilage directly. Cartilage is degraded by a complex inflammatory process. But RA patients with positive RF and/or positive anti-CCP have usually a more severe destructive disease than those with sero-negative disease (negative RF and anti-CCP)
3. The arthritis progresses in 4 defined stages: Early RA, Moderate progression, Severe progression and Terminal progression. There are clinical criteria (joint mobility, deformity...muscle atrophy) and radiologic criteria (juxta-articular osteoporosis, bone erosions, ankylosis...) for each stage.
Also 4 functional statuses are defined according to the ability of the patient to perform usual self-care, vocational, and avocational activities.
Majda Khoury - Thanks for sharing your experience and knowledge. Even though i am working in preclincal studies, Its really very helpful for me.
Sorry for the late answer
AS you know:
Positivity for RF is a marker for a more serious and more erosive disease. It is also true with anti-CCP. But anti-CCP and RF do not correlate well with activity. A possible explanation that anti-CCP do not correlate with activity is that anti-CCP is designed to be a very a specific diagnostic test. Anti-CCP is either negative or positive in high titers ( usually).
Another ACPA is the leser known anti-MCV test that seems to correlate with DAS and radiologic damage as well. Anti-MCV titers are distributed more homogenously (from low to very high titers) and are better suited than anti-CCP to measure disease activity. Treatment with infliximab has resulted to decreased anti-MCV titers.
You can find under my profile either a pre or post-print of the article published in clinical experimental Rheumatology.
I wish you and your family a happy new year.
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