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What is an Anti-cyclic Citrullinated Peptide (CCP) test?

An anti-CCP test is used to detect the presence of cyclic citrullinated peptides or anti-CCP antibodies in the bloodstream. Anti-CCP antibodies are a type of autoantibodies that are produced against citrullinated peptides (short-chain proteins that contain the amino acid citrulline in place of arginine) in the body.

Citrulline is one of the non-essential amino acids that is produced in the body from arginine by a process called citrullination. This leads to change in protein structure and generation of an immune response against it. In rheumatoid arthritis, the conversion of arginine to citrulline occurs at a much higher rate than normal, leading to inflammation and pain. An anti-CCP test helps detect this erosive and severe form of rheumatoid arthritis.

The alternate terms for this test are CCP antibodies, anti-CCP, anticitrullinated peptide antibodies and ACPA test.

  1. Why is an Anti-CCP test performed?
  2. How do you prepare for an Anti-CCP test?
  3. How is an Anti-CCP test performed?
  4. What do Anti-CCP test results indicate?

This test is mainly performed to identify and diagnose rheumatoid arthritis. It can also:

  • Determine the severity of the disease and the most suitable treatment needed
  • Be ordered if other RA tests do not provide desired results       
  • Differentiate between rheumatoid arthritis and other forms of arthritis

It is generally performed along with the rheumatoid factor (RF) test in people who have a history of undiagnosed inflammatory arthritis. Anti-CCP test can also be done as a follow-up test if the RF test is negative but clinical signs and symptoms are depictive of RA.

Common signs and symptoms of rheumatoid arthritis are as follows:

  • Pain and swelling in joints of arms and hands
  • Pain in other joints of the body, such as the shoulders, neck, hips and knee (Read more: Joint pain causes)
  • Morning stiffness in joints
  • Fever
  • Fatigue
  • Malaise (feeling of being unwell)
  • Development of nodules in the skin, particularly at elbows

No special preparations are needed for this test.

It can be done at any time of the day, and no fasting is required before this test. However, make sure that you inform your doctor about any current medications and supplements that you are taking since they can alter test results. Avoid taking any multivitamins and dietary supplements, which contain biotin (vitamin B7), eight hours prior to the test. Also, it is best that you wear a half-sleeved shirt for easy collection of blood. 

A blood sample will be drawn from a vein located on the back of your hand or inside of your elbow.

A sharp tool called lancet is used in young adults and children to puncture the skin and draw blood. Blood will be taken on a test strip, a slide or in a pipette (small glass tube).

After the test, slight pressure will be applied to the needle injection site to stop bleeding and a bandage will be placed over it to prevent infection.

Results may vary depending on age, gender and general health history of the person. Here are some ways anti-CCP test results show up:

  • Positive for both anti-CCP and RF: It can be indicative of rheumatoid arthritis. The severity and progress of the disease can also be determined.
  • Positive anti-CCP with a negative RF or low levels of both: It can be due to early rheumatoid arthritis or it can be an indication of a risk of rheumatoid arthritis in future.
  • Negative for anti-CCP but positive for RF: The clinical signs and symptoms need to be assessed to determine if the patient is having rheumatoid arthritis or other inflammatory conditions.
  • Negative results for both anti-CCP and RF: It indicates seronegative rheumatoid arthritis, especially if present with apparent RA symptoms. Such people may not have detectable antibody titre and may develop RA later in life.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.  

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  1. Holmes EW et al. Biotin Interference in Clinical Immunoassays: A Cause for Concern. Arch Pathol Lab Med. 2017 Nov;141(11):1459-1460. PMID: 29072950
  2. Appalachian Regional Healthcare System. Rheumatoid factor (RF). Watauga Medical Center, USA. [internet]
  3. Niewold TB, Harrison MJ, Paget SA. Anti-CCP antibody testing as a diagnostic and prognostic tool in rheumatoid arthritis. QJM. 2007 Apr;100(4):193-201. PMID: 17434910
  4. Lab tests online. Cyclic Citrullinated Peptide Antibody. American Association for Clinical Chemistry; Washington, D.C., United States [Internet]
  5. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Rheumatoid factor (RF)