Meta-analysis: Diagnostic Accuracy of Anti–Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor for Rheumatoid Arthritis

cyclic citrullinated peptide (CCP) are markers that might help phy-sicians diagnose rheumatoid arthritis. Purpose: To determine whether anti-CCP antibody more accurately identifies patients with rheumatoid arthritis and better predicts ra-diographic progression than does RF. Data Sources: MEDLINE through September 2006 and reference lists of retrieved studies and review articles. Study Selection: Studies in any language that enrolled at least 10 participants and that examined the role of anti-CCP antibody and RF in the diagnosis or prognosis of known or suspected rheumatoid arthritis. Data Extraction: Two authors independently evaluated studies for inclusion, rated methodological quality, and abstracted relevant data. Data Synthesis: The DerSimonian–Laird random-effects method was used to summarize sensitivities, specificities, and positive and negative likelihood ratios from 37 studies of anti-CCP antibody and 50 studies of RF. The pooled sensitivity, specificity, and positive and negative likelihood ratios for anti-CCP antibody were 67 % (95