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Autoantibodies play a central role in the clinical management of rheumatoid arthritis (RA). They can be used for diagnostic as well as prognostic purposes. For many years, autoantibody testing in RA was limited to rheumatoid factor (RF), but in the late 1990s, Schellekens and colleagues confirmed that autoantibodies reactive to citrullinated peptides were highly specific for RA1. The identification of antibodies to citrullinated peptide/protein antigens (ACPA) and the commercialization of ACPA testing in the form of anticyclic citrullinated peptide (CCP) antibody assays has revolutionized the field of rheumatology. The magnitude of the role of autoantibodies in RA is reflected in the current 2010 RA classification criteria in which autoantibodies can account for up to 3 of the 6 points (50%) needed to classify inflammatory arthritis as RA2.In the clinical management of patients with RA, earlier diagnosis and initiation of appropriate treatment is associated with improved longterm outcomes3. While there are many factors that influence delays in diagnosis and treatment of RA, autoantibodies are one factor that can influence these clinical outcomes. For example, Pratt and colleagues found that in patients referred to an early arthritis clinic who were ultimately diagnosed with RA, patients who were ACPA- and RF-negative had a significant delay in the time to treatment following assessment by a rheumatologist4. This finding highlights the diagnostic uncertainty that rheumatologists often face when patients with inflammatory … Address correspondence to Dr. M.K. Demoruelle, University of Colorado School of Medicine, Division of Rheumatology, 1775 Aurora Court, Mail Stop B-115, Aurora, Colorado 80045, USA. E-mail: Kristen.Demoruelle{at}UCDenver.edu

The Clinical and Research Implications of Anti-carbamylated Protein Antibodies