{"title":"Diagnostic accuracy of anti-carbamylated protein antibodies in rheumatoid arthritis: a systematic review and meta-analysis.","authors":"Pannathorn Nakaphan, Patavee Pajareya, Priabprat Jansem, Somkiat Phutinart, Nattanicha Chaisrimaneepan, Tanattida Kassels, Noppachai Siranart","doi":"10.1007/s00296-025-05992-3","DOIUrl":null,"url":null,"abstract":"<p><p>Anti-carbamylated protein (anti-CarP) antibodies have emerged as novel serologic markers in rheumatoid arthritis (RA). This meta-analysis aimed to assess the diagnostic accuracy of anti-CarP antibodies in RA patients.A systematic Literature search was conducted through April 2025. Primary outcome was diagnostic accuracy of anti-CarP antibodies compared to healthy controls; secondary outcomes included subgroup analyses by anti-citrullinated protein antibodies (ACPA) status.Thirty-six studies (7431 RA patients; 3347 healthy controls) were included. Most used in-house ELISA platforms. Overall, Anti-CarP antibodies showed high specificity but Limited sensitivity in detecting RA with pooled sensitivity and specificity of 44% (95% CI: 39-49%, I²=91.5%) and 96% (95%CI: 94-97%, I²=65.5%), respectively. The pooled diagnostic odds ratio was 14.72 (95%CI: 10.75-20.15, I<sup>2</sup> = 62.1%), and the area under the summary receiver operating characteristic (SROC) curve was 0.825 (95%CI: 0.797-0.854). In subgroup analysis with studies using carbamylated fetal calf serum as targeted antigen (n = 16), sensitivity and specificity were 41% (95%CI: 38-45%, I²=82.3%) and 96% (95%CI: 95-98%, I²=59.6%). In ACPA-negative patients, sensitivity was 24% (95%CI: 18-31%, I²=87.2%), and specificity was 95% (95%CI: 93-97%, I²=70.3%) with the area under the SROC of 0.755 (95%CI: 0.705-0.805). In ACPA-positive patients, sensitivity was 49% (95% CI: 41-57%, I²=94.0%), and specificity was 95% (95%CI: 93-97%, I²=72.0%) with the area under the SROC of 0.855 (95% CI: 0.806-0.904).Anti-CarP antibodies demonstrate high specificity but limited sensitivity for RA diagnosis. PROSPERO registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251065177 .</p>","PeriodicalId":21322,"journal":{"name":"Rheumatology International","volume":"45 10","pages":"232"},"PeriodicalIF":2.9000,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Rheumatology International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00296-025-05992-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Anti-carbamylated protein (anti-CarP) antibodies have emerged as novel serologic markers in rheumatoid arthritis (RA). This meta-analysis aimed to assess the diagnostic accuracy of anti-CarP antibodies in RA patients.A systematic Literature search was conducted through April 2025. Primary outcome was diagnostic accuracy of anti-CarP antibodies compared to healthy controls; secondary outcomes included subgroup analyses by anti-citrullinated protein antibodies (ACPA) status.Thirty-six studies (7431 RA patients; 3347 healthy controls) were included. Most used in-house ELISA platforms. Overall, Anti-CarP antibodies showed high specificity but Limited sensitivity in detecting RA with pooled sensitivity and specificity of 44% (95% CI: 39-49%, I²=91.5%) and 96% (95%CI: 94-97%, I²=65.5%), respectively. The pooled diagnostic odds ratio was 14.72 (95%CI: 10.75-20.15, I2 = 62.1%), and the area under the summary receiver operating characteristic (SROC) curve was 0.825 (95%CI: 0.797-0.854). In subgroup analysis with studies using carbamylated fetal calf serum as targeted antigen (n = 16), sensitivity and specificity were 41% (95%CI: 38-45%, I²=82.3%) and 96% (95%CI: 95-98%, I²=59.6%). In ACPA-negative patients, sensitivity was 24% (95%CI: 18-31%, I²=87.2%), and specificity was 95% (95%CI: 93-97%, I²=70.3%) with the area under the SROC of 0.755 (95%CI: 0.705-0.805). In ACPA-positive patients, sensitivity was 49% (95% CI: 41-57%, I²=94.0%), and specificity was 95% (95%CI: 93-97%, I²=72.0%) with the area under the SROC of 0.855 (95% CI: 0.806-0.904).Anti-CarP antibodies demonstrate high specificity but limited sensitivity for RA diagnosis. PROSPERO registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251065177 .
期刊介绍:
RHEUMATOLOGY INTERNATIONAL is an independent journal reflecting world-wide progress in the research, diagnosis and treatment of the various rheumatic diseases. It is designed to serve researchers and clinicians in the field of rheumatology.
RHEUMATOLOGY INTERNATIONAL will cover all modern trends in clinical research as well as in the management of rheumatic diseases. Special emphasis will be given to public health issues related to rheumatic diseases, applying rheumatology research to clinical practice, epidemiology of rheumatic diseases, diagnostic tests for rheumatic diseases, patient reported outcomes (PROs) in rheumatology and evidence on education of rheumatology. Contributions to these topics will appear in the form of original publications, short communications, editorials, and reviews. "Letters to the editor" will be welcome as an enhancement to discussion. Basic science research, including in vitro or animal studies, is discouraged to submit, as we will only review studies on humans with an epidemological or clinical perspective. Case reports without a proper review of the literatura (Case-based Reviews) will not be published. Every effort will be made to ensure speed of publication while maintaining a high standard of contents and production.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.