There are many infections, connective tissue diseases, malignancies, and advancing age factors associated with false-positive RF tests. A positive anti-CCP and negative RF blood test show that you may be in the early stages of the disease or may have it in the future. CCP IGG Blood Test Results Explained - HRF Preventing intense false positive and negative - ScienceDirect Michou L, Teixeira VH, Pierlot C, Lasbleiz S, Bardin T, Dieude P, et al. (PPTX 48 kb). About 70% of RA patients test positive for anti-CCP antibodies [4, 23]. Development of the anti-citrullinated protein antibody repertoire prior to the onset of rheumatoid arthritis. Furthermore, the 100% positive predictive value of anti-CCP Abs confers a remarkable advantage on this serum marker in comparison with RF. SelfDecode does not treat, diagnose or cure any conditions, 2005;52(12):38138. If CCP antibodies are found in your blood, it can be a . Clinical Utility of Common Serum Rheumatologic Tests | AAFP In other words, the blood test (RF) can be positive for years before the joint pain develops. Rheumatoid Factor Is Negative: What Does It Mean? - CreakyJoints If not ordering electronically, complete, print, and send a, Although late RA prognosis may be linked to adverse consequences, early diagnosis has been reported to improve outcomes; notably reduced joint destruction or deformity, delayed radiologic progression, and decreased functional disability. Rubella vaccination and transitory falsepositive test results for Privacy If you test positive for anti-CCP and are diagnosed with RA, your doctor will likely pursue a more aggressive treatment regimen. Though Lyme disease is treatable, it can become disastrous if left untreated. Joe Cohen flipped the script on conventional and alternative medicine and it worked. Because rheumatoid factor antibody binds to normal antibodies, it can be generally referred to as an autoantibody. Cite this article. Arthritis Rheum. Celiac disease. This might be partly due to strict criterion of threshold of citrullination dependency (absorbance difference between anti-CAP and anti-CCP 0.1) for low absorbance level samples. Therefore, the clinical significance of the presence of the anti-CCP antibody in non-RA CTD patients remains unclear. Article anti-CCP antibodies appear early in RA and can predate the clinical onset of disease by years - most, but not all, patients are also positive for RF; anti-CCP is associated with joint damage - this is the case even in those patients who are RF-negative. The reactivities to CAP and CCP of sera from RA-overlapping CTD patients and non-RA CTD patients were measured by an in-house ELISA and absorbance values at 415nm, and the absorbance values of anti-CAP antibodies were subtracted from those of anti-CCP antibodies for each patient. They were first reported by Henry Kunkel, H.R. . but is for informational and educational purposes alone. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Shiboski SC, Shiboski CH, Criswell L, Baer A, Challacombe S, Lanfranchi H, et al. The present results revealed that anti-CCP-positive non-RA CTD patients rarely developed RA. Antirheumatic therapy should not be initiated based solely on a positive test for CCP antibodies, and changes in treatment should not be based upon the levels of CCP antibodies. Conclusion: There are a number of possible explanations for false-positive HBV serology in a patient with seropositive RA: RhF may non-specifically bind the test antigen reagent used in the assay; RhF (an IgM class anti-human IgG antibody) could bind the mouse mAb IgG used in the assay; and the patient's serum may contain anti-drug antibodies . About 20% of RA patients are seronegative, meaning that their RF and anti-CCP lab results both continue to come back . Normally, the immune system is tolerant of these proteins, but in patients with RA, the body mounts an immune response and creates antibodies to target and destroy these citrullinated proteins [1]. [ 1, 2, 3 . 2010;49(12):2298304. Joe Cohen flipped the script on conventional and alternative medicineand it worked. Frontiers | False Positive Results in SARS-CoV-2 Serological Tests for CCP - Overview: Cyclic Citrullinated Peptide Antibodies, IgG, Serum Kasukawa R TT, Miyawaki S, Yoshida H, Tanimoto K, Nobunaga M, Suzuki T, Takasaki Y, Tamura T. Preliminary diagnostic criteria for classification of mixed connective tissue disease: In: Kasukawa R, Sharp GC (Eds) Mixed Connective Tissue Disease and Antinuclear Antibodies. However, most labs do not offer this test yet [1, 18]. Once a patient develops a positive anti-CCP, it will usually remain positive, despite remission. This includes a combination of medications called disease-modifying antirheumatic drugs (DMARDs) that includes methotrexate (Trexall) and biologics (drugs made from living organisms) such as infliximab (Remicade) and etanercept (Enbrel) [29, 4]. Verheul MK, Bohringer S, van Delft MAM, et al: Triple positivity for anti-citrullinated protein autoantibodies, rheumatoid factor, and anti-carbamylated protein antibodies conferring high specificity for rheumatoid arthritis: Implications for very early identification of at-risk individuals. A positive anti-CCP and positive RF blood test indicate there is a strong chance you have RA. These patients may develop RA in the future because the emergence of anti-citrullinated protein antibodies (ACPA), including the anti-CCP antibody, precedes the onset of RA [3,4,5,6]. 2021 Feb;73(2):181-193, 5. Ann Rheum Dis. All statistical analyses were conducted using R version 3.6.3. Although all 60 samples tested positive for the anti-CCP antibody using a commercial ELISA kit, 5 out of 33 RA-overlapping CTD and 6 out of 27 non-RA CTD serum samples tested negative using our in-house CCP ELISA. Thirty-three anti-CCP-positive non-RA CTD patients were retrospectively followed up for the development of RA. Ann Rheum Dis. Anti-Sm antibody binds to a protein that is attached to DNA. An ANA test detects antinuclear antibodies (ANA) in your blood. the false-positive rate in this subgroup was approximately 10%. 2 We assessed isoagglutinin titers in a candidate for ABOi-living donor kidney transplantation (A to O) who was treated by a humanized anti-CD38 IgG monoclonal antibody (daratumumab) a week before for multiple myeloma. K Ohmura: Received research grants and/or speakers fees from Abbvie, Actelion, Asahikasei Pharma, Astellas, AYUMI, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Janssen, JB, Mitsubishi Tanabe, Nippon Kayaku, Nippon Shinyaku, Novartis, Sanofi, and Takeda. Ann Rheum Dis. Primary Biliary cirrhosis, an autoimmune disease of the biliary ducts in the liver. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. A positive result by itself does not automatically lead to a diagnosis. Long-term follow-up of patients with anti-cyclic citrullinated peptide Clin Chem Lab Med. A microfluidic platform for detection and quantification of two Fingerstick tests give you results within 10 minutes, allowing your doctor to give you immediate feedback [21]. Tasliyurt T, Kisacik B, Kaya SU, Yildirim B, Pehlivan Y, Kutluturk F, et al. There are also tests that you can take at your doctors office which only require a blood sample from a finger prick. 2019 Apr 3;5(1):e000870, 4. Kakumanu P, Yamagata H, Sobel ES, Reeves WH, Chan EK, Satoh M. Patients with pulmonary tuberculosis are frequently positive for anti-cyclic citrullinated peptide antibodies, but their sera also react with unmodified arginine-containing peptide. Therefore, we retrospectively investigated whether anti-CCP antibody-positive non-RA CTD patients developed RA and clarified whether HLA-DRB1 SE and the citrullination dependency of the anti-CCP antibody are predictive factors for RA. Marked differences in fine specificity and isotype usage of the anti-citrullinated protein antibody in health and disease. RA was diagnosed according to the 1987 revised American College of Rheumatology classification criteria. Undiagnosed Lyme can develop into chronic Lyme, cause debilitating mental health symptoms, spread throughout the body - for example, to the neurological system or the heart - and wreak havoc on patients' quality of life. (10) Based on these studies, there exist a subset of patients with RA who are negative for RF and ACPA IgG (seronegative) who must be diagnosed clinically or with use of emerging diagnostic tests. is currently the most widely used anti-citrullinated peptide assay. (2) RF is an autoantibody directed against the Fc portion of immunoglobulin while ACPA are directed against peptides and proteins containing citrulline, a modified form of the amino acid arginine. Blood Tests for Autoimmune Diseases - Verywell Health antibodies are routinely tested for by ELISA at Clinipath. Anti-dsDNA Test - Testing.com Based on these findings, a higher anti-CCP antibody titer and the presence of SE appear to be important factors in the development of RA, not only in the general population, but also in the anti-CCP-positive CTD population. Left untreated, it can lead to other health problems such as thyroid disorders, low bone density and intestinal cancers. After further incubation and washing to remove unbound conjugate, substrate (3,3',5,5' tetramethylbenzidine) is added and allowed to incubate. Despite the high specificity of the test, anti-CCP antibodies have also been observed in psoriatic arthritis. RFs are used as a marker in individuals with suspected rheumatoid arthritis (RA) or other autoimmune conditions. Lupus Blood Test Results: What to Know | HSS Rheumatology 2009;60(1):308. Rheumatoid factor is an antibody that is not usually present in the normal individual. Arthritis Res Ther 22, 248 (2020). Until recently, rheumatoid factor (another antibody involved in RA) was the only antibody used to help diagnose the disease. PDF Autoantibodies related to systemic autoimmune with COVID-19 1) and 31 anti-CCP-positive non-RA CTD patients (group 3 in Fig. We appreciate Dr. Xinghao Wang for the critical reading of the manuscript. Furthermore, our observation period, 8.9years, was sufficiently long to assess the outcomes of the anti-CCP-positive population because the median period during which an anti-CCP-positive population developed RA was previously reported to be 4.5years [4]. Different patterns of associations with anti-citrullinated protein antibody-positive and anti-citrullinated protein antibody-negative rheumatoid arthritis in the extended major histocompatibility complex region. Clinical judgments were based on the following classification criteria: the American College of Rheumatology (ACR) 1997 criteria [17] or the new Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria [18] for SLE, the ACR 2012 classification criteria [19] for primary Sjgrens syndrome (pSS), the ACR 1980 classification criteria [20] for systemic sclerosis, the Bohan and Peter diagnostic criteria [21] for polymyositis/dermatomyositis, the Kasukawas criteria for mixed connective tissue disease (MCTD) [22], the Yamaguchi criteria for adult-onset Stills disease (AOSD) [23], and the Assessment in SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis [24]. In comparisons of characteristics between anti-CCP-positive non-RA CTD patients and RA-overlapping CTD patients, the Mann-Whitney U test was used for continuous variables and Fishers exact test for categorical variables. 1 Introduction. Additionally, anti-CCP antibodies have been shown to be predictive of the progression of patients, indicating more . Significantly elevated levels of CCP antibodies may be useful to identify RA patients with erosive joint disease. 1. 2019 Oct 25;57(11):1668-1679, Cyclic citrullinated peptide (CCP) antibodies in serum are detected by binding to the wells of a commercial microtiter plate coated with synthetic CCP. Group 1 consists of patients who fulfilled the 1987 revised American College of Rheumatology (ACR) criteria of RA before the anti-CCP antibody test was performed, group 2 consists of patients who fulfilled the 1987 ACR criteria in the follow-up period, and group 3 consists of patients never fulfilled the 1987 ACR criteria. Sensitivity/specificity of citrullination dependency for predicting RA development in the population of anti-CCP positive patients with arthritis (n=39) was 96%/18%, and PPV/negative predictive value (NPV) of that was 75%/67%. The false-positive rate of anti-CCP is difficult to come by. Antibodies directed against the Fc fragment of immunoglobulin G (IgG) are called rheumatoid factors (RFs). Low levels of anti-CCP can be found in the test results of certain patients but may not enough to produce a positive result. ESR and CRP Polymyositis and dermatomyositis (first of two parts). Previous studies reported that 410% of non-RA CTD patients tested positive for the anti-CCP antibody [1, 2], which is consistent with the present results. Anti-CCP antibodies, also called CCP antibodies, are a type of antibody called autoantibodies. 1988;31(3):31524. HLA-DRB1 SE and anti-CCP antibody titers may facilitate the differentiation of RA-overlapping CTD from anti-CCP-positive non-RA CTD. Antirheumatic therapy should not be initiated based solely on a positive test for CCP antibodies, and changes in treatment should not be based upon the levels of CCP . Ann Rheum Dis. 2008;58(6):157681. However, ACPA-positive healthy subjects, which account for 12% of the population [12, 13], do not have higher frequency of HLA-DRB1 SE [13]. Arthritis Rheum. Rheumatoid Factor - Medscape Despite its high specificity, previous studies reported that 510% of non-RA connective tissue disease (CTD) patients tested positive for the anti-CCP antibody [1, 2]. One other test that can help is the anti-CCP antibody test. (3-5), 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative, Clients without access to Test Prices can contact, Prospective clients should contact their account representative. The positive predictive value (PPV) of anti-CCP antibody for erosive arthritis was calculated in each disease subset (n=65, groups 1, 2, and 3 with X-ray images in Fig. The test is ordered when a person displays signs and/or symptoms of rheumatoid arthritis. Symptoms: They're extremely varied. Hensvold AH, Frisell T, Magnusson PK, Holmdahl R, Askling J, Catrina AI. Arthritis Rheumatol. Thirty-nine out of the 62 RA-overlapping CTD patients tested positive for the anti-CCP antibody (62.9%). 2009;61(11):147283. There are many infections, connective tissue diseases, malignancies, and advancing age factors associated with false-positive RF tests. A positive result for cyclic citrullinated peptide (CCP) antibodies may be suggestive of rheumatoid arthritis (RA) if compatible clinical features of disease are present. Highest rates of false-positive RF tests were found in patients with SLE (18.3% vs. 12.7% CCP), Sjgren's syndrome (73.3% vs. 3.3% CCP), and a control group with chronic hepatitis (24.7% vs. 1.3% CCP). A Mayo prospective clinical evaluation of the CCP antibody test showed a diagnostic sensitivity for RA of 78% with fewer than 5% false positive results in healthy controls (see Cautions). Kakumanu P, Sobel ES, Narain S, Li Y, Akaogi J, Yamasaki Y, et al. Anti-CCP is commonly produced when you have rheumatoid arthritis. . Anti-CCP antibody titers were obtained from a retrospective chart review for 445 patients or were measured using the stored sera of 397 patients. However, limited information is currently available on the long-term outcomes of anti-CCP-positive non-RA CTD patients. In the most common scenario, Lyme triggers false positive tests for rheumatoid arthritis, usually rheumatoid factor, but occasionally anti-CCP antibodies; and, these antibodies disappear when Lyme is successfully treated. Required fields are marked *. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Severe acute respiratory syndrome coronavirus 2 (SARSCoV2) is a novel viral agent that can cause a life-threatening respiratory disorder named coronavirus disease 2019 (COVID19). Long-term follow-up of patients with anti-cyclic citrullinated peptide antibody-positive connective tissue disease: a retrospective observational study including information on the HLA-DRB1 allele and citrullination dependency. When both are positive, a 3-tiered cascade reporting algorithm is activated (Figure 1A). We also calculated the OR of developing RA for SE possession in patients with any smoking history (past smokers+current smokers, n=9) to account for any confounding effects of smoking on RA. (1) Clinically, RA is typified by progressive damage of synovial joints, inflammation, production of diverse autoantibodies, and variable extra-articular manifestations. Arthritis Care Res. Patients presenting with mono or pauciarticular pain of large joints with positive anti CCP antibody assay have to be investigated to rule out the possibility of early stage of tubercular arthritis before labeling them as of rheumatoid arthritis. Provided by the Springer Nature SharedIt content-sharing initiative. In the present study, we used the 1987 ACR criteria, not the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria [26], because the latter are not applicable to patients with symptoms that may be attributed to another disease, including CTD, and also include the anti-CCP antibody. Antibodies are proteins that your immune system makes to fight foreign substances like viruses and bacteria. The false-positive syphilis test was the first recognized test for antiphospholipid antibodies, but it is now known that people can have antiphospholipid antibodies without having . As a result, we found significant effect on developing RA (OR Inf (95% CI 0.7-Inf), p value 0.048). You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. LymeMD: Elevated rheumatoid factor -- and anti-CCP antibodies - Blogger Anti-CCP antibodies are commonly found in rheumatoid arthritis patients and are thought to play a key role in the disease process. If a patient tests positive for anti-CCP this is a strong indicator of RA. van Venrooij WJ, van Beers JJ, Pruijn GJ. Despite its high specificity, previous studies reported that 5-10% of non-RA connective tissue disease (CTD) patients tested positive for the anti-CCP antibody [1, 2].These patients may develop RA in the future because the emergence of anti-citrullinated protein antibodies . The aim of this study was to evaluate the specificity of SARS-Cov-2 serological assays using . Growing up, he suffered from inflammation, brain fog, fatigue, digestive problems, insomnia, anxiety, and other issues that were poorly understood in traditional healthcare. Anti-citrullinated protein antibodies (ACPAs) are autoantibodies (antibodies to an individual's own proteins) that are directed against peptides and proteins that are citrullinated.They are present in the majority of patients with rheumatoid arthritis.Clinically, cyclic citrullinated peptides (CCP) are frequently used to detect these antibodies in patient serum or plasma (then referred to as . We are dedicated to providing the most scientifically valid, unbiased, and comprehensive information on any given topic. We reported the first case of SLE manifestation . Ann Rheum Dis. Objective: We sought to characterize a novel cohort of patients with lung disease, anti-cyclic citrullinated peptide (CCP) antibody positivity, without rheumatoid arthritis (RA) or other connective tissue disease (CTD). Burgers LE, Raza K, van der Helm-van Mil AH: Window of opportunity in rheumatoid arthritis - definitions and supporting evidence: from old to new perspectives. (4,6,10) A systemic review and meta-analysis of 33 studies including patients with RA and healthy or disease controls demonstrated the sensitivity of anti-mutated citrullinated vimentin, anticyclic citrullinated peptide, and RF of 71%, 71%, 77%, with the specificity of 89%, 95%, 73%, and the area under the curve of the summary receiver operating characteristic of 89%, 95%, 82%, respectively. Systemic lupus erythematosus (SLE): when active, usually a homogenous pattern on ANA or less commonly speckled, rim, or nucleolar when present in high enough titer to be . Arthritis Rheum. Anti-CCP (Cyclic Citrullinated Peptide) Anti-Citrullinated Ab. X-rays of the hands and feet were taken for all patients in groups 1 and 2, and in 25 out of 31 patients in group 3. A CCP antibodies test measures the level of these autoantibodies. Cross M, Smith E, Hoy D, et al: The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. 2014;66(12):181827. Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. Background Many clinicians are aware that certain therapies administered to their patients can have downstream consequences in the form of clinical laboratory test interferences. Rheumatologic Tests: A Primer for Family Physicians | AAFP CAP, the arginine version of CCP (the citrulline residues of CCP were converted to arginine), and CCP were coated on the same plate, and reactivities against CAP and CCP were compared. MAMvd and LAT evaluated citrullination dependency by ELISA. Interpretation in the clinical context is important. When we compared clinical, serological, and genetic features between non-RA CTD and RA-overlapping CTD patients, we found not only the presence of joint symptoms, bone erosion, and RF, which were all included in the 1987 revised ACR criteria [25], but also a higher anti-CCP titer and more prevalent HLA-DRB1 SE in RA-overlapping CTD patients (Table2). Our science team must pass long technical science tests, difficult logical reasoning and reading comprehension tests. Methods: The study sample included 74 subjects with respiratory symptoms, evaluated January 2008-January 2010 and found to have a positive anti-CCP antibody but no evidence for . (4,7,9) For more information see Connective Tissue Disease Cascade. While RA is a lifelong disease, diagnosing it early and treating it properly will give the best chance at controlling its progression and allowing you to live a healthy and active lifestyle. Aggarwal R, Liao K, Nair R, Ringold S, Costenbader KH. it signifies and erosive subset of any arthritis. TI and SN analyzed the data. Anti-citrullinated peptide antibody assays and their role in the diagnosis of rheumatoid arthritis. The ANA test is not specific to any one disease, but a high level of ANA can be a sign of systemic lupus erythematosus (SLE). Ann Rheum Dis. (2) We evaluated only anti-CCP-positive patients and did not re-evaluate the serology of anti-CCP negative CTD patients, some of whom may have newly developed anti-CCP antibody. Anti CCP antibody assay may be false positive in many patients of tubercular synovitis. Association between SARSCoV2 and SLE is not clear. These antibodies react with CAP, which is the arginine version of CCP (the citrulline residues of CCP were replaced by arginine). The present results revealed that anti-CCP-positive non-RA CTD patients rarely developed RA. (10) Based on these studies, there exist a subset of patients with RA who are negative for RF and ACPA IgG (seronegative) who must be diagnosed clinically or with use of emerging diagnostic tests.(4,7,9). There were no significant differences between the two groups (p=0.15). 2003;48(10):27419. In patients with a suspected connective tissue disorder and a positive ANA titer, further testing (e.g., anti-double-stranded DNA antibodies, anti-Smith antibodies, Sjgren antibodies) should . When faced with a positive rheumatoid factor, it's important to rule out other conditions that cause positivity. Antinuclear Antibody Panel: Purpose, Results, and Risks - Healthline Your email address will not be published. In the present study, we focused on differences in the citrullination dependency of the anti-CCP antibody. The normal level of anti-CCP antibodies is less than 20 units/mL. When rheumatoid arthritis is present, the body is perceiving its own tissues, joints, and organs as foreign invaders. Hensvold AH, Magnusson PK, Joshua V, Hansson M, Israelsson L, Ferreira R, et al. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Aletaha D, Neogi T, Silman AJ, et al: 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Terao C, Ohmura K, Kochi Y, Ikari K, Maruya E, Katayama M, et al. He belongs to the department that is financially supported by five pharmaceutical companies (Mitsubishi-Tanabe Pharma Corp., Chugai Pharmaceutical Co., Ltd., Ayumi Pharmaceutical Corp., Asahi-Kasei Pharma Corp., and UCB Japan Co., Ltd.). Arthritis Rheum. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Anti-CCP is a blood test. Note that each number in parentheses [1, 2, 3, etc.] Ding B, Padyukov L, Lundstrom E, Seielstad M, Plenge RM, Oksenberg JR, et al. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Autoantibodies can cause disease by attacking the body's healthy cells by mistake. Ann N Y Acad Sci. 1). However, we could not find any significant association of citrullination dependency with erosive disease (OR=4.4 (95% CI 0.3244), p value=0.3). Flow chart of the classification of patients with connective tissue disease (CTD). (6,7) In addition to the use of RA and ACPA IgG to diagnose RA, RF and ACPA isotype antibodies and other serologic biomarkers have been used to predict if, and when, an individual who has inflammatory arthritis (IA) may develop future clinically apparent IA and access genetic and/or environmental risks. They are more often found in severe forms of the disease and increase the risk of more rapid destruction of the joints [3, 8, 4]. Anti Citrullinated Antibody. Ann Rheum Dis. A flow chart of the present study is shown in Fig. CCP Antibody Test: MedlinePlus Medical Test 2012;64(4):47587. These include [15]: A rheumatoid factor (RF) test is commonly ordered alongside an anti-CCP test to help make a diagnosis. Join me! | Uses of Anti-CCP in Early Rheumatoid Arthritis The concentration of CCP antibodies is determined by comparison to a 5-point standard curve (15.6-250 U). These antibodies are made as a direct attack of specific proteins found naturally in the body. Citrullination dependency was evaluated using an in-house ELISA at the Leiden University Medical Center, as described previously [27]. 01. Rheumatology Labs 101 | Hospital Handbook 2005;52(11):34338. CAS Even patients with Rheumatoid arthritis can have a positive ANA.

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