Anti CCP antibodies

[Zill8]

A recent blood test has confirmed that my anti CCP antibody level is abnormal ie above high reference limit. Does this mean I don’t have PMR and do have late onset rheumatoid arthritis. I will hopefully be seeing a rheumatologist soon but I am asking this group because I upped my Pred from 12.5 to 15 this week in the hope of relief. I am maybe marginally improved but can’t see the point in higher doses if it’s not PMR and would like to start slowly reducing. Thank you.

[PMRpro Ambassador]

It does make it very much less likely that it is PMR. yes. In a letter to the BMJ, Prof Dasgupta (a trustee of the charity) said

"The lack of a laboratory test causes difficulties in distinguishing true polymyalgia rheumatica (PMR) from other inflammatory rheumatic diseases.1 An important differential diagnosis is rheumatoid arthritis (RA), which has been reported to develop in up to a third of patients.2

Antibodies to cyclic citrullinated peptides (CCP) are considered to have 96% specificity for RA.3 A study comparing 57 patients with elderly onset RA with 49 patients with PMR found that 65% in the first group were anti-CCP positive, whereas none of the patients with PMR were positive."

Medscape also has an article saying the same thing.

emedicine.medscape.com/arti...

Pred is used a lot to relieve symptoms early in an RA diagnosis until the DMARD can start to work which may be up to 6 months so it isn't entirely useless. However, the rheumatologist is likely to want to see you without pred interfering with your symptoms do it certainly would make sense to stop the pred before you see them.

Do you know when it might be? It used to be that an RA referral was dealt with fast because the sooner you start treatment the better and apart from pred which isn't a DMARD the GP can't initiate anything. But at present - who knows ...

[Zill8 in reply to PMRpro]

Thank you. The waiting list is 16 weeks here but I have asked for a private referral. I daren't stop the pred as I was in agony and completely immobile before I started it in January but my try to reduce down to about 10 if I can.

[PMRpro Ambassador in reply to Zill8]

As Gala123 says, they are not mutually exclusive so you might hope the rheumy will suggest a PET-CT but they are expensive to do privately. They also really need you to be off pred. But PMR does often show peripheral arthritis signs - so is it one, the other, both? DIfficult to say ...

[Gala123]

one does not exclude the other, unfortunately. I was initially diagnosed with PMR, then was told - not PMR, but inflammatory arthritis, started methotrexate, then had a PET scan and it showed PMR with large vessel involvement. Now I am considered to have both, but my rheumy said that there is no way to tell if I have both or it is IA with PMR features or PMR with arthritis featured. Steroids are widely used in RA anyway. Good luck figuring it out. It would be worth having a discussion with your doctor.

[Zill8 in reply to Gala123]

Thank you. I will try to reduce a little.