Iwasaki, T., Nakabo, S., Terao, C. et al. 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. 1 Introduction. 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. (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. Testing positive for anti-CCP antibodies increases the risk of developing a more aggressive form of rheumatoid arthritis. Flow chart of the classification of patients with connective tissue disease (CTD). The false-positive rate of anti-CCP is difficult to come by. N Engl J Med. Anything over this level means that you test positive for the antibodies and anything below means you test negative [8]. Development of the anti-citrullinated protein antibody repertoire prior to the onset of rheumatoid arthritis. 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 . A positive result in combination with other signs and symptoms means you have rheumatoid arthritis. Emery P, Breedveld FC, Dougados M, Kalden JR, Schiff MH, Smolen JS: Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Until recently, rheumatoid factor (another antibody involved in RA) was the only antibody used to help diagnose the disease. CCP antibodies, also called anti-CCP antibodies, are a type of antibody called autoantibodies. 2009;36(12):268290. They are found in around 30-40% of patients with SLE. Arthritis Rheum. 2011;70(12):21349. The normal level of anti-CCP antibodies is less than 20 units/mL. Privacy SelfDecode has the strictest sourcing guidelines in the health industry and we almost exclusively link to medically peer-reviewed studies, usually on PubMed. 2021 Feb;73(2):181-193, 5. The dependency on citrullination was evaluated by subtracting absorbance values of anti-CAP from that of anti-CCP. For more information see Connective Tissue Disease Cascade. 1), and the mean CTD duration period at anti-CCP testing was 10.19.4years. Horizontal dashed lines in a and b represent the cut-off level (=0.1) of citrullination dependency. To investigate whether the anti-CCP antibody became negative over time, we obtained the latest anti-CCP antibody titer in January 2020 from the medical records of 64 anti-CCP-positive CTD patients whose anti-CCP antibody titers had been measured. Bohan A, Peter JB. Furthermore, no reaction was seen when the structurally similar but antigenically unique control peptide was used in the assay using ChonBlock (Fig. In a systematic review from 2010, it was found that false positivity can also occur in chronic . 2002 Apr;61(4):290-297, 6. 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. These antibodies are in fact present (real) but they are NOT elevated because of . Early detection of anti-CCP antibodies is crucial to properly treat the disease and stop its progression [10]. Anti-CCP antibodies, also called CCP antibodies, are a type of antibody called autoantibodies. The frequency of the HLA-DRB1 shared epitope (SE) and anti-CCP antibody titers were both significantly higher in anti-CCP-positive RA-overlapping CTD patients than in anti-CCP-positive non-RA CTD patients, while no significant differences were observed in citrullination dependency. Many patients with other autoimmune disorders and inflammatory conditions test positive for rheumatoid factor but don't have rheumatoid arthritis. A rough guide to the disease associations of ENAs is provided in Table 1. 2009;61(11):147283. In a Mayo Clinic study (see Interpretation), the false-positive rate in this subgroup was approximately 10%. What Are Anti-cyclic Citrullinated Peptide Antibodies and why are they elevated in RA? Anti-cyclic citrullinated peptide positivity in non-rheumatoid arthritis disease samples: citrulline-dependent or not? This is particularly true of laboratory tests that depend on, or directly involve the use of, antibody-based methodology. A positive result for cyclic citrullinated peptide (CCP) antibodies may be suggestive of rheumatoid arthritis (RA) if compatible clinical features of disease are present. 2005;52(11):34338. Anti-CCP antibody titers were obtained from a retrospective chart review or measured using stored sera. Arthritis Research & Therapy Anti-CCP antibody titers were obtained from a retrospective chart review for 445 patients or were measured using the stored sera of 397 patients. Anti-cyclic citrullinated peptide antibodies in type 1 autoimmune hepatitis. Arthritis Rheum. 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]. Arthritis Rheum. Ohmura K, Terao C, Maruya E, Katayama M, Matoba K, Shimada K, et al. All data were analyzed anonymously. However anti-CCP is not associated with extraarticular features (unlike RF) variation of . Antibodies are . Ann Rheum Dis. In addition, we calculated the association of citrullination dependency with erosive disease. False positives are also known to happen in about 5% of tests when a person would be classified as healthy. Arthritis Rheum. The anti-CCP antibody test may also be referred to as an ACPA antibody test. 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. Around 30% of RA patients test negative for both antibodies [24]. This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. 2006;65(8):11102. The aim of this study was to evaluate the specificity of SARS-Cov-2 serological assays using . However, ACPA-positive healthy subjects, which account for 12% of the population [12, 13], do not have higher frequency of HLA-DRB1 SE [13]. It affects about 0.6% of the US population with a global prevalence of 0.24%. We are dedicated to providing the most scientifically valid, unbiased, and comprehensive information on any given topic. In other words, the blood test (RF) can be positive for years before the joint pain develops. Primary Biliary cirrhosis, an autoimmune disease of the biliary ducts in the liver. 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]. 2019 Apr 3;5(1):e000870, 4. Almost all patients with lupus have a positive ANA test. However, it isnt a very sensitive marker, which means that a negative result does not necessarily rule out rheumatoid arthritis [10]. Ann Rheum Dis. We appreciate Dr. Xinghao Wang for the critical reading of the manuscript. 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. The higher the levels of anti-CCP antibody, the more likely it is to suggest RA. This immune activation destroys healthy tissue in the joints and worsens RA symptoms [3]. 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. Arthritis Rheum. In addition to improving symptoms and preventing and reducing joint damage, these medications can reduce anti-CCP levels substantially [30, 31, 4]. Enzyme-Linked Immunosorbent Assay (ELISA). If you also test positive for RF, you likely have the disease [25]. This ANA testing method led to an increase in rheumatology referrals for RNP . Aliment Pharmacol Ther. Terms and Conditions, 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. CT, KM, RN, MH, YI, NY, HY, YM, KY, TM, TF, TMi, and KO contributed to the collection of samples and/or data. Ding B, Padyukov L, Lundstrom E, Seielstad M, Plenge RM, Oksenberg JR, et al. Since the emergence of the anti-CCP antibody may have preceded the onset of RA in these patients, anti-CCP-positive non-RA CTD patients may be more susceptible to developing RA than indicated by the present results. Therefore, SE has potential as a genetic marker to distinguish RA from non-RA in the ACPA-positive population. If that is positive, that makes the diagnosis of RA much more likely meaning that the patient, even if aymptomatic now, is likely to develop it down the road. Your email address will not be published. Cite 28th Dec, 2015 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 . Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. However, it has been shown that false postive serological results often occured while detecting antibodies directed against SARS-CoV-2 in patients with . Therefore, the clinical significance of the presence of the anti-CCP antibody in non-RA CTD patients remains unclear. CAS Anti-CCP. 2010 Sep;62(9):2569-2581, 3. Anti-citrullinated peptide antibody assays and their role in the diagnosis of rheumatoid arthritis. Ryu YS, Park SH, Lee J, Kwok SK, Ju JH, Kim HY, et al. 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]. Rheumatoid factors are proteins produced by your immune system that can attack healthy tissue in your body. Preliminary criteria for classification of adult Still's disease. Anti-Sm antibody binds to a protein that is attached to DNA. Arthritis Rheumatol. Preliminary criteria for the classification of systemic sclerosis (scleroderma). The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. https://doi.org/10.1186/s13075-020-02351-4, DOI: https://doi.org/10.1186/s13075-020-02351-4. Ann Rheum Dis. Michou L, Teixeira VH, Pierlot C, Lasbleiz S, Bardin T, Dieude P, et al. 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. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Re-testing later on may be required in . 1, 7.6%). Interpretation in the clinical context is important. The anti-cyclic citrullinated peptide antibody (anti-CCP) test (which has a high specificity for rheumatoid arthritis), full blood count (cytopaenias are a feature of SLE), urinalysis (haematuria and/or proteinuria may be due to renal manifestations of autoimmune disease), serum complement proteins C3 and C4 (low complement can reflect . (PPTX 48 kb). There is a newer version of the test that has improved sensitivity, which reduces the chance of a false negative. The diagnoses of the 780 non-RA CTD patients and prevalence of the anti-CCP antibody in each disease are shown in Table1. Google Scholar. In these cases, your doctor will need to factor in the severity of your symptoms, CRP and ESR, and imaging tests [27]. However, the target population in the present study was pSS patients who were cross-sectionally evaluated, and RA-overlapping CTD patients were not excluded when anti-CCP antibody titers were measured. Today, anti-histone antibodies are still used as a marker for systemic lupus . However, in 2010, the American College of Rheumatology changed their criteria for diagnosing RA to include the presence of anti-CCP antibodies [9]. Association between SARSCoV2 and SLE is not clear. TI and SN measured anti-CCP antibody titers by ELISA. 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. Anti-CCP antibodies are commonly found in rheumatoid arthritis patients and are thought to play a key role in the disease process. Your immune system normally makes antibodies to help you fight infection. Holman, and H.R.G. Anti-cyclic citrullinated peptide (anti-CCP) antibodies are commonly found in patients with rheumatoid arthritis (RA), an autoimmune disorder that destroys the joints throughout the body [1]. The present study was supported in part by JSPS KAKENHI (grant no. Antibodies protect you from disease by fighting foreign substances like viruses and bacteria. 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 . 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. As a result, we found significant effect on developing RA (OR Inf (95% CI 0.7-Inf), p value 0.048). Anti-CCP-positive non-RA CTD patients rarely developed RA. Sixty-two patients were diagnosed with RA-overlapping CTD before the anti-CCP test was performed. The prevalence of the anti-CCP antibody was consistent with previous findings [2, 14, 30], except for a larger number of anti-CCP-positive patients with polymyositis/dermatomyositis than in a previous study conducted in a Western country [2]. 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. This test is 97% specific for RA if it is present. 2008;67(6):8017. is a clickable link to peer-reviewed scientific studies. CTD onset times were available for 64 out of 72 patients (groups 1,2, and 3 in Fig. 2a). Because of this, most assays detect only IgM. 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. 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). The present results revealed that anti-CCP-positive non-RA CTD patients rarely developed RA. Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Arthritis Rheum. Arthritis Rheum. (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). T Fujii: Received speaking fees and/or honoraria from Abbvie, Astellas, Asahi-kasei, Chugai, Eli Lilly, Eisai, Janssen, Kissei, Mitsubishi-Tanabe, Ono, Pfizer, Sanofi, Taisho Toyama, Takeda, and UCB, and has received research grants from AbbVie, Ayumi, Asahi-kasei, Astellas, Chugai, Daiichi-Sankyo, Eli Lilly, Eisai, Kissei, Mitsubishi-Tanabe, Pfizer, Nippon-Kayaku, Ono, Takeda, and UCB. 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. An antinuclear antibody test is a blood test that looks for certain kinds of antibodies in your body. The possession of HLA-DRB1 SE was also compared between 22 non-RA CTD patients and 32 RA-overlapping CTD patients. Anti CCP antibody assay may be false positive in many patients of tubercular synovitis. Intravenously-administered immunoglobulin therapy is one such treatment that can in theory . False positives are more common with RF than anti-CCP. Anti-CCP antibodies may also be detected in other inflammatory diseases and conditions involving the joints and connective tissue, including [4, 5, 6, 7]: Anti-CCP antibodies belong to a family of similar antibodies known as anti-citrullinated protein antibodies (ACPAs) [5]. The presence of ANA antibodies at levels of 1:160 or higher are generally taken as a sign of lupus. On the other hand, 33 out of 780 non-RA CTD patients (4.2%) tested positive for the anti-CCP antibody. American College of Rheumatology classification criteria for Sjgrens syndrome: a data-driven, expert consensus approach in the Sjgrens International Collaborative Clinical Alliance cohort. Anti-CCP antibody titers were measured based on the discretion of physicians or when serum or plasma was stored regardless of joint symptoms. (3-5) To facilitate early diagnosis, the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria recommend testing for rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA). What is a high CCP blood test? Anti Citrulline. Cite this article. Treating RA early on (within 6 after symptoms begin) is crucial in preventing the disease from progressing and reducing joint damage and disability [28]. The reference range in this kit is less than 4.5U/mL, with a level of 100 and higher being calculated as 100 because the upper limit measured in old cases was 100. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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. Rheumatoid arthritis (RA) is a chronic, systemic inflammatory . Diagnosis requires a positive celiac blood test and small intestine biopsy. 3.2.2. Our team comprises of trained MDs, PhDs, pharmacists, qualified scientists, and certified health and wellness specialists. These antibodies react with CAP, which is the arginine version of CCP (the citrulline residues of CCP were replaced by arginine). Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common red blood cell enzyme . A sample was considered to be citrullination-dependent when the anti-CCP antibody titer was higher than the cut-off (25 arbitrary U/mL) and the absorbance values at 415nm value for CCP was 0.1 higher than that for CAP [28]. Arthritis Rheum. (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. Lets look at how doctors use this test as an auto-immune marker. Terao C, Ohmura K, Kochi Y, Ikari K, Maruya E, Katayama M, et al. 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. Thus, the presence of anti-CCP Abs must be interpreted as highly suggestive of a diagnosis of EORA. However, the presence of immunoglobulins causing pan-agglutination can cause false-positive results. In both patients with primary and SLE associated APS positive results correlate with a predisposition for arterial or venous thrombosis, foetal loss, or thrombocytopoenia. One of the limitations of the present study is that information on when the anti-CCP antibody became positive was not obtained for 39 anti-CCP-positive RA-overlapping CTD patients (group 1 in Fig. Vannini A, Cheung K, Fusconi M, Stammen-Vogelzangs J, Drenth JP, Dall'Aglio AC, et al. RF can also be found in patients that don't have rheumatoid arthritis at all. MAMvd and LAT evaluated citrullination dependency by ELISA. 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). Arthritis Rheum. Approximately 70% of patients with rheumatoid arthritis are positive for Anti-CCP IgG, while only about 2% of random blood donors and disease controls subjects are positive. Arthritis Rheumatol. In contrast, antinuclear antibodies often attack your body's own tissues specifically targeting each cell's nucleus. Polymyositis and dermatomyositis (first of two parts). What it is: A genetic, autoimmune disease where ingested gluten damages the small intestine. Article A positive anti-CCP and positive RF blood test indicate there is a strong chance you have RA. The test is ordered when a person displays signs and/or symptoms of rheumatoid arthritis. The false-positive rate of anti-CCP is difficult to come by. 7 Anti-CCP antibodies and anticitrullinated filaggrin antibodies are . Doctors use the anti-CCP antibody test to help diagnose rheumatoid arthritis and determine if more aggressive treatment is needed to address the disease. a Comparison of citrullination dependency between rheumatoid arthritis (RA)-overlapping connective tissue diseases (CTD) and non-RA CTD patients. 2015;74(2):37580. Anti-CCP antibodies are the most specific test for diagnosing RA [16, 17]. Additionally, anti-CCP antibodies have been shown to be predictive of the progression of patients, indicating more . Anti-CCP antibody, a marker for the early detection of rheumatoid arthritis. Knowing the symptoms of autoimmune joint disease is of utmost importance as well. Tests with lower rates of sensitivity will produce more false negative results. INOVA Diagnostics; 02/2020). Background: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are considered highly specific markers of rheumatoid arthritis. Joe Cohen flipped the script on conventional and alternative medicine and it worked. Anti-CCP is commonly produced when you have rheumatoid arthritis. (2-4) Patients with RA may be categorized based on the phase of disease (early versus established), presence or absence of antibodies (seropositive versus seronegative), clinical manifestations (joint erosion, interstitial lung disease, or cardiovascular), or specific risks (genes, gender, or smoking). The present study was performed in accordance with the Helsinki Declaration and was approved by Kyoto University Graduate School and Faculty of Medicine Ethics Committee (approval numbers: E458 and R1540). Arthritis Rheum. A plus sign next to the number [1+, 2+, etc] means that the information is found within the full scientific study rather than the abstract. Rantapaa-Dahlqvist S, de Jong BA, Berglin E, Hallmans G, Wadell G, Stenlund H, et al. They are continually monitored by our internal peer-review process and if we see anyone making material science errors, we don't let them write for us again. suggested that pSS patients who test positive for the anti-CCP antibody subsequently develop RA [31]. SI Abnormal Reports. 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 . The frequency of antibodies against cyclic citrullinated peptides and rheumatoid factor in healthy population: a field study of rheumatoid arthritis from northern Turkey. These antibodies are made as a direct attack of specific proteins found naturally in the body. Left untreated, it can lead to other health problems such as thyroid disorders, low bone density and intestinal cancers. Nielen MM, van Schaardenburg D, Reesink HW, van de Stadt RJ, van der Horst-Bruinsma IE, de Koning MH, 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. Anti-cardiolipin antibodies are by definition a major criterion for a diagnosis of APS. 2009;60(1):308. Low levels of anti-CCP can be found in the test results of certain patients but may not enough to produce a positive result. The prevalence of HLA-DRB1 SE in RA-overlapping CTD and non-RA CTD patients was similar to that in ACPA-positive RA patients and healthy subjects in a previous study, respectively [11]. Normal Reports | . PubMed 2008;58(6):157681. The normal level of anti-CCP antibodies is less than 20 units/mL. 1). Even if you test negative for both anti-CCP and RF antibodies this also doesnt rule out RA when you are experiencing symptoms. Links with this icon indicate that you are leaving the CDC website.. If you test positive for anti-CCP antibodies, yet youre healthy and arent showing symptoms of RA, you have a much greater risk of developing the disease [19]. 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. A negative result by itself does not rule out the disease. A large-scale association study identified multiple HLA-DRB1 alleles associated with ACPA-negative rheumatoid arthritis in Japanese subjects. Cross M, Smith E, Hoy D, et al: The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. The rheumatoid factor is not clinically significant. A rheumatoid factor test measures the amount of rheumatoid factor in your blood. Prevalence of arthritis in anti-CCP-positive non-RA CTD patients is shown in Supplementary Table1, Additionalfile2. About 20% of RA patients are seronegative, meaning that their RF and anti-CCP lab results both continue to come back . 26460649). Autoimmune hepatitis, an autoimmune disease of the liver. Arthritis Rheum. Abnormal Reports, SI Normal Reports | A blood sample is drawn from the patient and analyzed in a lab. Differential Diagnosis. Google Scholar. Associations between genetic factors, tobacco smoking and autoantibodies in familial and sporadic rheumatoid arthritis. X-rays of the hands and feet were taken in January 2020 to establish whether anti-CCP-positive non-RA CTD patients had developed bone erosions. Rheumatol Int. If not ordering electronically, complete, print, and send a General Request (T239) with the specimen. Part of To assess the reliability of the diagnosis, we evaluated all SLE patients by chart review and found that all patients fulfilled the ACR 1997 or SLICC 2012 criteria. 2006;65(7):84551. Ann Rheum Dis.