Cyclic Citrullinated Peptide (CCP) Lab Values

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Demonstrate understanding of Cyclic Citrullinated Peptide lab value and its use in clinical practice.


Lab Test Name:

Cyclic Citrullinated Peptide Lab Value




An early, highly specific diagnostic evaluation of presence of anti-CCP antibodies

  • Autoantibodies
    • Antibodies made by the immune system  
  • Diagnostic tool for Rheumatoid Arthritis when combined with Rheumatoid Factor lab
  • Detected on average 3-5 years prior to clinically significant development of RA



S/S of Rheumatoid Arthritis:

  • Pain, swelling, and stiffness in the joints
  • Fatigue
  • Unexplained low-grade fever

Detection of:

  • Rheumatoid Arthritis
    • unknown specific etiology 
    • linked to complex interactions between genes and the environment


Normal Therapeutic Values:

Normal result:

  • <19 units 

Collection via serum separator tube


What would cause increased levels?

Increased levels: <20 units/ml

  • preclinical phase of disease 
  • associated with future RA development 
  • may predict radiographic joint destruction


What would cause decreased levels?

Decreased level observed in patients who have been effectively treated

  • <19 units/ml


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Hey everyone. This is Abby with Our lab lesson is going to cover cyclic citrullinated peptide, abbreviated as CCP. Let’s get started. Cyclic citrullinated peptide or CCP is a lab that’s used to detect antibodies in a patient serum or plasma. If the anti CCP antibodies are present along with a positive rheumatoid factor, that leads to a diagnosis of rheumatoid arthritis. This is actually a very highly specific and early diagnostic tool to lead to this diagnosis and can actually lead to better patient outcomes. Some clinical indications for this would be patients that have signs and symptoms of rheumatoid arthritis. That’s going to be pain and swelling stiffness in the joints like this poor individual here, they might be very fatigued and they may even have an unexplained low grade fever. Normal values for this test are somewhat interesting. If it’s below 19 units per mL, the patient is considered negative.


This is when we want to be negative. Collection for this is through a serum separator tube or a gold top. When lab values are increased, meaning they’re greater than 20 units per mL, this is the preclinical phase of the disease. This is going to tell us that this is a high likelihood that the patient will develop rheumatoid arthritis. Look at all that inflammation in the joint. If it’s decreased or below 19 units per mL, that means, or is evaluated in patients and seen as effective treatment for rheumatoid. Some linchpins for this lesson are that the cyclic citrullinated peptide ia a lab value that detects the antibodies that were formed in response to the peptide being present in the body. A normal value is below 19 units per mL and considered negative. An increased value would be greater than 20 units per mL, and shows a strong likelihood that rheumatoid arthritis is the diagnosis. But remember this lab doesn’t stand alone in evaluation. We have to have a positive rheumatoid factor in addition to it, in order to actually lead to our diagnosis of rheumatoid arthritis. Now, what we want to see are decreased values, decreased values, show us evidence that treatment has been effective. Everybody did great this lesson. You can do this. This wraps up our lesson on CCP. Now go out and be your best self today. And as always happy nursing.



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