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rected for the total amount of the corresponding classspecific immunoglobulin (2), i.e., IgG anti-CCP (unit)/total
IgG (gm/liter). In our study, this approach showed that RA
patients with serum anti-CCP had synovial fluid anti-CCP/
IgG ratio higher than that in RA patients with no serum
anti-CCP antibodies (see Table 1). Moreover, in this last
group 2 patients exhibited anti-CCP/IgG ratio values above
the cut-off (2.22 units/gm/liter) calculated as the value for
the upper 95th percentile in synovial fluid of osteoarthritis
In conclusion, our results suggest that the synovial fluid
determination of anti-CCP antibodies should be reserved
for selected cases (i.e., seronegative patients for these
autoantibodies) taking into account the correction for the
total amount of the corresponding immunoglobulin.
Antonio Spadaro, Prof
Valeria Riccieri, MD
Rossana Scrivo, MD
Cristiano Alessandri, MD
Guido Valesini, Prof
University of Rome
Rome, Italy
1. Caspi D, Anouk M, Golan I, Paran D, Kaufman I, Wigler I, et al.
Synovial fluid levels of anti– cyclic citrullinated peptide antibodies and IgA rheumatoid factor in rheumatoid arthritis, psoriatic arthritis, and osteoarthritis. Arthritis Rheum 2006;55:
53– 6.
2. Vossenaar ER, Smeets TJ, Kraan MC, Raats JM, van Venrooij
WJ, Tak PP. The presence of citrullinated proteins is not specific for rheumatoid synovial tissue. Arthritis Rheum 2004;50:
3. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF,
Cooper NS, et al. The American Rheumatism Association 1987
revised criteria for the classification of rheumatoid arthritis.
Arthritis Rheum 1988;31:315–24.
4. Weinberger A, Simkin PA. Plasma proteins in synovial fluids
of normal human joints. Semin Arthritis Rheum 1989;19:66 –
DOI 10.1002/art.22114
To the Editors:
We thank Drs. Spadaro et al for their interest in our
article and for their results, which indeed support our
observation, that anti-CCP can be found in synovial fluid
of patients with RA. We found significant correlation between serum and synovial fluid anti-CCP levels, without
considering the anti-CCP/IgG ratio suggested by Spadaro et
al. The calculation of anti-CCP/IgG ratio presented by the
authors, although theoretically reasonable did not seem to
significantly improve the sensitivity or specificity of the
assay. In contrast, the calculation disclosed results above
the cut-off in 2 of the osteoarthritis patients’ synovial fluid
Our study aimed at detecting the presence of anti-CCP in
synovial fluids of patients with RA, and at showing that
these findings are specific for RA. We do not suggest synovial fluid anti-CCP as a routine diagnostic test, in accordance with the view of Spadaro et al. However, some
patients with anti-CCP seronegative RA may demonstrate
positive synovial fluid anti-CCP results (in our study 3 of
14 patients, data not shown). In conclusion, elevated levels of anti-CCP are present in the synovial fluid of RA
patients, and their testing may offer some additive diagnostic value in selected cases.
Dan Caspi, MD
Ori Elkayam, MD
Tel Aviv Medical Center
Tel Aviv, Israel
Submissions Invited for Themed Issue of Arthritis Care & Research:
Cost and Social and Psychological Impact of Rheumatic Diseases
Arthritis Care & Research is soliciting manuscripts for a themed issue addressing the economic cost and
social and psychological impact of rheumatic diseases. Manuscripts covering a broad range of topics related
to the major theme are invited; for example, economic cost, and social and psychological impacts on
individuals, health care providers, and society; extent of and risk factors for disability in activities; and
evaluation of public policies to reduce the impact of rheumatic diseases. Submissions from a range of
disciplines are welcome, and we will entertain both original research articles and review articles.
The issue will include regular submissions as well, but a certain number of pages will be reserved for
manuscripts accepted in response to this solicitation. All manuscripts will be peer-reviewed. All types of
manuscripts (e.g., original articles, contributions from the field, case studies, trainee rounds, reviews) are
included in this solicitation.
The deadline for submission is June 1, 2007. For further information, contact the editors of Arthritis
Care & Research, Edward H. Yelin, PhD ([email protected]) or Patricia P. Katz, PhD ([email protected]).
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