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Aim: The study objective was to evaluate the diagnostic value of synovial fluid anti cyclic citrullinated peptide (sf-anti CCP) in comparison to serum anti CCP (s-anti CCP) in early and late rheumatoid arthritis and to clarify its correlation with disease activity.  Methods: In this cross-sectional study a total of 45 patients aged between 18 and 70 years with rheumatoid arthritis (RA) according to the ACR criteria were enrolled. Twenty six patients had a disease duration of more than 2 years (late RA) whereas 19 cases were referred to as early RA (<2 yrs). Baseline characteristics and laboratory studies including complete blood count (CBC), erythrocyte sedimentation rate (ESR) in addition to anti CCP and rheumatoid factor (RF) levels in the serum and synovial fluid were recorded. Disease activity was assessed according to disease activity score of 28 joints - ESR (DAS28 - ESR).  Results: Serum and synovial fluid anti CCP correlated significantly (p<0.001, r=0.6). Sf-anti CCP also significantly correlated with sf-RF (p=0.02, r=0.34). No correlation was found between sf-anti CCP and disease activity according to DAS28-ESR (p=0.38, r=0.13). There also was no statistically significant difference between early and late RA in terms of sf-anti CCP (p=0.9).  Conclusion: The diagnostic value of sf-anti CCP for RA is similar to s-anti CCP. Therefore, sf-anti CCP can be useful if RA is suspected. The current study did not show any difference in sf-anti CCP between early and late RA and revealed no correlation with disease activity.

Synovial Anti Cyclic Citrullinated Peptide Antibodies in Comparison with Serum Antibodies in Early and Late Rheumatoid Arthritis