Objective: This meta-analysis explored the diagnostic value of anti-cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor (RF) for rheumatoid arthritis (RA) in the Asian population.
Methods: Embase, Medline, Cochrane Library, Chinese Science and Technology Periodicals, China National Knowledge Infrastructure, and China Wanfang Databases were searched from 1 January 2000 to 1 February 2021 to collect studies on the combined detection of anti-CCP and RF for diagnosing RA. The sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were combined and analyzed. Summary receiver operating characteristic (SROC) curves were drawn.
Results: Twenty-four published papers were analyzed, including 21 combined in series and 8 combined in parallel. In the tandem analysis, the sensitivity = 0.64 [95% confidence interval (CI): 0.58-0.70], specificity = 0.97 (95%CI: 0.95-0.98), +LR = 19.70 (95%CI: 12.74-30.46), -LR = 0.37 (95%CI: 0.31-0.43), DOR = 53.43 (95%CI: 34.46-82.40), and area under the SROC curve = 0.89. In the parallel combination, the sensitivity = 0.87 (95%CI: 0.80-0.92), specificity = 0.76 (95%CI: 0.67-0.84), +LR = 3.68 (95%CI: 2.62-5.17), -LR = 0.17 (95%CI: 0.11-0.26), DOR = 21.56 (95%CI: 11.63-39.99), and area under the SROC curve = 0.89.
Conclusion: Anti-CCP and RF combined detection improves the diagnostic efficiency of RA, providing a potential strategy for early clinical screening in the Asian population.This trial was retrospectively registered in the INPLASY/Research Registry (https: //inplasy.com/) with the registration number INPLASY202180106.
Keywords: Cyclic citrullinated peptide; diagnosis; meta-analysis; rheumatoid arthritis; rheumatoid factor; screening.