Table of ContentsView AllTable of ContentsPurposeDiagnosing RARA SeverityOther ConditionsRisksTest Results
Table of ContentsView All
View All
Table of Contents
Purpose
Diagnosing RA
RA Severity
Other Conditions
Risks
Test Results
The cyclic citrullinated peptide (CCP) test measures CCP antibodies in the blood. These proteins are part of an immune system attack on healthy tissues and cells, such as the joints. A healthcare provider may order this test to help diagnoserheumatoid arthritis(RA).
Another common name for this is the anti-cyclic citrullinated peptide (anti-CCP) test. Other names include:
This article discusses cyclic citrullinated peptides. It explains what they are, how the CCP antibody test is used to evaluate them, and what your results may mean.
What Does the CCP Test Measure?
The CCP antibody test measures cyclic citrullinated peptide antibodies (Immunoglobulin G, or IgG) in the blood. The test is used to diagnose RA, determine the severity of the disease, and detect other autoimmune disorders.
Cyclic citrullinated peptides are circular proteins that contain citrulline. When inflammation is present, the body converts the amino acidarginineto the amino acidcitrulline.
Do I Need to Fast for a CCP Test?Unless your healthcare provider tells you otherwise, you do not need to fast before a CCP test. You can eat and drink as normal before the test. You should be able to resume normal activities immediately and do not need to take any special precautions.
Do I Need to Fast for a CCP Test?
Unless your healthcare provider tells you otherwise, you do not need to fast before a CCP test. You can eat and drink as normal before the test. You should be able to resume normal activities immediately and do not need to take any special precautions.
Diagnosing Rheumatoid Arthritis
The CCP antibody test is part of a series of blood work used to diagnose rheumatoid arthritis.Your healthcare provider may order a CCP antibody and other tests if you have RA symptoms such as:
What Is a Normal Cyclic Citrullinated Peptide?A normal level of CCP antibodies is less than 20 units per milliliter (U/mL). This is considered a negative test result.
What Is a Normal Cyclic Citrullinated Peptide?
A normal level of CCP antibodies is less than 20 units per milliliter (U/mL). This is considered a negative test result.
Other RA Tests
The CCP antibody blood test is one component of diagnosing RA. While a positive CCP test result indicates an autoimmune condition, a negative result does not rule it out. CCP results are negative at the time of diagnosis about half the time.
There is no single test that can diagnose RA. Instead, the results of the CCP are viewed alongside other tests, including:
If both your CCP and RF antibody tests are positive, then you are likely to have RA. You may also have imaging tests to check your joints for damage, such as an X-ray, MRI, or ultrasound scan.
Determining Severity of Rheumatoid Arthritis
In addition to helping your healthcare provider diagnose RA, a CCP antibody test may also predict the severity of the disease and possible damage.
A positive CCP antibody test increases the chances of a person having a more advanced RA with more joint damage.
Detecting Other Autoimmune Disorders
It is rare for someone to have cyclic citrullinated peptide antibodies in their blood without also having RA. However, other autoimmune conditions can also test positive for CCP antibodies.
Autoimmune conditions that may show positive test results for CCP antibodies include:
What Is Rheumatoid Arthritis?
Risks and Contraindications
The CCP antibody blood test is a low-risk procedure, like most blood tests. You may have some pain, swelling, or bruising where the needle enters your vein during the blood draw.
Occasionally, ahematoma(swelling of pooled blood) may form under your skin. If you are prone to bruising or the area is sore, you can apply an ice pack to the area for 15 minutes. Otherwise, these side effects should resolve on their own in a few days. Tell your healthcare provider if the symptoms persist or get worse.
If you feel dizzy or lightheaded at any point during or after the test, tell the healthcare professional. You may need to lie down until this passes. Usually, these symptoms resolve quickly on their own, but you may also be given something to eat or drink.
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Interpreting CCP Test Results
The amount of time it takes to receive your results can vary. You may have to wait a couple of days or a week. Check with your healthcare provider if you are concerned about the waiting period. Your practitioner should receive the results and communicate with you.
Reference Ranges: What Is Low, Normal, and High?
When you receive the test results, you will see numbers in a reference range. They may be reported in either U/mL (units per milliliter).
Reference ranges for test results (may vary depending on the precise test used):
A negative CCP antibody blood test means you do not have detectable antibodies, but you may still have rheumatoid arthritis. It is possible for a person to have a negative test result and have RA at the same time.
A positive CCP antibody test means you have these antibodies in your blood and may have RA. A strong positive test result means you have more of the CCP antibodies in your blood, so you are even more likely to have RA.
How Accurate Is a CCP Test?The CCP antibody blood test is generally considered to be accurate and specific when results are positive, indicating RA is likely. However, the antibodies are not present in up to three-fourths of all people at or before a diagnosis, so having a negative test result does not entirely rule out the possibility of RA.
How Accurate Is a CCP Test?
The CCP antibody blood test is generally considered to be accurate and specific when results are positive, indicating RA is likely. However, the antibodies are not present in up to three-fourths of all people at or before a diagnosis, so having a negative test result does not entirely rule out the possibility of RA.
If you have a weak positive blood test, your healthcare provider may recommend testing again in a couple of weeks or months to see if the results change. Your practitioner may also order CCP antibody tests periodically to see if your RA treatments are working.
Since there is no single test for diagnosing RA, your healthcare provider may order other imaging and blood tests in addition to the CCP antibody test. Talk to your practitioner to see which tests are best for you.
If you are diagnosed with RA, your healthcare provider will help you figure out the next steps. You may need to make some lifestyle changes, such as improving your diet, getting enough exercise, and reducing stress. You may also have to takemedications for RA.
Summary
A positive CCP antibody test is an indication of rheumatoid arthritis and other autoimmune conditions. A negative result, however, does not definitively rule out RA and other inflammatory conditions. Your healthcare provider will review your CCP antibody test results along with other tests before making a diagnosis.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Arthritis Foundation.Rheumatoid arthritis.
Quest Diagnostics.Cyclic citrullinated peptide (CCP) antibody (IgG).
Braschi E, Shojania K, Allan GM.Anti-CCP: a truly helpful rheumatoid arthritis test?Can Fam Physician. 2016 Mar;62(3):234. PMID: 26975916; PMCID: PMC4984588.
Iwasaki T, Nakabo S, Terao C,et al.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.Arthritis Res Ther. 2020;22(1):248. doi:10.1186/s13075-020-02351-4
Vannini A, Cheung K, Fusconi M, et al.Anti-cyclic citrullinated peptide positivity in non-rheumatoid arthritis disease samples: citrulline-dependent or not?.Ann Rheum Dis. 2007;66(4):511-516. doi:10.1136/ard.2006.058933
National Heart, Lung, and Blood Institute.Blood tests.
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