Does a positive anti-CCP test confirm rheumatoid arthritis?

Hello,

Welcome to icliniq.com.

I understand your concern.

I have gone through the information that you have provided me (attachments removed to protect the patient’s identity). The Anti-CCP (anti-cyclic citrullinated peptide) test that you have done is positive. This, when seen in conjunction with symptoms like joint pains and morning stiffness, clearly indicates that you might be having rheumatoid arthritis.

Anti-CCP antibodies are very specific markers for rheumatoid arthritis, but there are a few other diseases where they could be present, albeit very rarely. However, a final diagnosis needs to be made on the basis of your symptoms and other lab results.

The importance of diagnosing and treating rheumatoid arthritis lies in the fact that, without treatment, it causes joint destruction and bone erosions even within two years from the onset of the disease.

Prior to commencing treatment, I would suggest undergoing comprehensive tests, which include liver function tests, kidney function tests, and autoimmune tests. This will help to ascertain the diagnosis and associated diseases, as well as ensure the safety of treatment initiation.

I would suggest the following investigations:

• Complete blood count.

• Erythrocyte sedimentation rate.

• C-reactive protein.

• Alanine aminotransferase.

• Aspartate aminotransferase.

• Serum creatinine.

• Rheumatoid factor.

• Antinuclear antibody (ANA) by immunofluorescence (IF) technique.

• Hepatitis B surface antigen.

• Hepatitis C virus antibody.

• Tuberculin skin test or another screening test for tuberculosis.

• Chest X-ray.

• X-ray of both hands.

In case of diagnosis of rheumatoid arthritis and absence of contraindications, the patient should undergo the following therapy:

• Prednisolone 20 milligrams (mg) once daily for two weeks, followed by gradual withdrawal according to the instructions of your doctor.

• Methotrexate 15 mg once weekly; this medication is a first-line DMARD (disease-modifying antirheumatic drug) in the treatment of rheumatoid arthritis.

• Folic acid 5 mg once weekly, administered 24 hours after Methotrexate to prevent adverse reactions.

• Calcium and vitamin D supplementation if needed.

Blood tests should be performed regularly due to the possible adverse effects on the functioning of the liver, kidneys, and hematological parameters caused by this drug. In case of poor results of the therapy, the dosage of Methotrexate can be slowly increased up to 25 mg once a week.

In case of persistent high levels of disease activity in spite of sufficient therapy, your rheumatologist may recommend additional or replacement of your current DMARD with bDMARDs or another advanced agent.

I advise you to take the following steps:

• To have enough rest during the episodes of disease activity.

• To perform range-of-motion and strengthening exercises regularly according to the instructions of your physiotherapist.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.

Hello,

Welcome back to icliniq.com.

I have understood your problem.

If you are intolerant to Prednisolone, you can use an oral NSAID (nonsteroidal anti-inflammatory drug) for two weeks to help reduce the pain and inflammation, as well as until the Methotrexate starts acting.

One such choice would be Diclofenac, a maximum dosage of which will be 150 mg/day, if it is suitable for you and there are no contraindications. The effect of Methotrexate usually comes in four to six weeks.

The laboratory values you have shared with me are fine, with no abnormalities detected in them. However, I suggest completing the other laboratory investigations that I suggested earlier.

I hope this helps you.

Thank you.