Evaluation of Anti-Cyclic Citrullinated Peptide (Anti-CCP) Positivity in RA-Negative Patients with Joint Pain
1Department of Microbiology, Dr. S.N Medical College, Jodhpur, India 2Department of IHBT, Mahatma Gandhi Medical College, Jaipur, India
*Corresponding author
Abstract:
Rheumatoid arthritis (RA) diagnosis traditionally relies on Rheumatoid Factor (RF), but RF negativity in clinically suspected cases may delay recognition and treatment. Anti-Cyclic Citrullinated Peptide (Anti-CCP) antibodies demonstrate higher specificity and may identify patients at risk for early or evolving RA even when RF is negative. To evaluate the diagnostic significance of Anti-CCP positivity in RF-negative patients presenting with joint pain and assess its implications for early RA detection. This retrospective analytical study included 1,494 patients with joint pain who underwent both RF and Anti-CCP testing. Patients were categorized based on combined serological status. Special emphasis was placed on the RF-negative Anti-CCP–positive subgroup. Chi-square (χ²) testing assessed association between RF and Anti-CCP, while Odds Ratio (OR) and proportion analysis evaluated diagnostic likelihood and clinical relevance. A p-value <0.05 was considered statistically significant. Of 1,494 patients, 213 (14.25%) were RF positive and 1,281 (85.75%) were RF negative. Anti-CCP positivity was observed in 121 patients (8.1%). Importantly, 53 patients (4.35%) were RF-negative but Anti-CCP positive, accounting for 43.8% of all Anti-CCP–positive cases. There was a statistically significant association between RF and Anti-CCP reactivity (χ², p < 0.001). Anti-CCP–positive individuals demonstrated significantly higher odds of RF positivity, while RF-negative Anti-CCP–positive patients represented a clinically important “at-risk” population for evolving RA. A substantial proportion of Anti-CCP–positive patients in this cohort were RF negative, underscoring the value of Anti-CCP testing in suspected RA, particularly when RF is negative. Incorporating Anti-CCP testing enhances diagnostic precision, supports early disease recognition, and may facilitate timely therapeutic intervention to prevent long-term joint damage. Anti-CCP should therefore be considered an essential biomarker in evaluating patients with persistent joint pain.
Keywords: Rheumatoid arthritis (RA), Rheumatoid Factor (RF), Anti-Cyclic Citrullinated Peptide (CCP)
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How to cite this article:
Jayant Ramawat, Deepak Kanjani and Amrin Khan. 2026. Evaluation of Anti-Cyclic Citrullinated Peptide (Anti-CCP) Positivity in RA-Negative Patients with Joint Pain.
Int.J.Curr.Microbiol.App.Sci. 15(1): 48-52. doi:
https://doi.org/10.20546/ijcmas.2026.1501.005
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National Academy of Agricultural Sciences (NAAS) 
