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Objective  To evaluate the diagnostic accuracy of anticarbamylated protein antibodies (CarP), alone and in combination with traditional biomarkers (rheumatoid factor [ RF ] and anticitrullinated peptide antibodies [ ACPA ]), in established rheumatoid arthritis ( RA ).    Methods  A commercially available enzyme‐linked immunosorbent assay ( ELISA ) kit was used to assess CarP concentrations in serum samples of 200 established  RA  and 206 controls (115 healthy donors and 55 patients with other rheumatic diseases). Main outcome measures were sensitivity, specificity, and area under the curve ( AUC ; 95% confidence interval [ CI ]). Difference in accuracy was evaluated by comparison of the respective  AUC s.    Results  A serum CarP cut‐off of 1.47 ng/ml or more differentiated patients with  RA  from controls with 30% sensitivity, 97.1% specificity, and good accuracy ( AUC [95% CI ] = 0.83[0.79‐0.86],  P  < 0.0001). However, it showed moderate diagnostic accuracy in seronegative  RA  patients: sensitivity 17.9%, specificity 96.9%, and  AUC  (95%  CI ) = 0.69 (0.63‐0.75). The diagnostic accuracy of CarP_ ACPA  and CarP_ RF  combinations was significantly superior to that of  ACPA  and  RF  alone ( P  < 0.0001 and  P  = 0.015, respectively), but not to that of  ACPA _ RF  combination ( P  = 0.089) In addition, the CarP_ ACPA _ RF  combination did not improve the diagnostic accuracy of the  ACPA _ RF  combination ( AUC  mean difference [95%  CI ] = 0.006 [−0.001 to 0.015],  P  = 0.10). The number of positive autoantibodies (0, 1, 2, or 3) was not significantly associated with moderate‐severe disease (Disease Activity Score‐28 [ DAS ‐28] > 3.2) in adjusted multiple regression analysis.    Conclusion  CarP has good diagnostic accuracy in established  RA  but not in seronegative  RA . The addition of CarP to  ACPA  and  RF  alone or in combination does not significantly enhance the diagnostic accuracy of  ACPA _ RF  combination.

Diagnostic Accuracy of Anticarbamylated Protein Antibodies in Established Rheumatoid Arthritis: A Monocentric Cross‐Sectional Study