{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T18:11:23Z","timestamp":1788631883262,"version":"build-2803163510"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":228,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research (NIHR) Exeter Biomedical Research Centre"},{"name":"NIHR Exeter Health Tech Research Centre"},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Department of Health and Social Care"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are alternative diagnostic tests for RA with similar sensitivity. Anti-CCP antibodies have improved specificity compared with RF and so should result in fewer false positives. A retrospective, observational study was conducted following a change in the primary care pathway and test for inflammatory arthritis from RF to anti-CCP antibodies, assessing real-world impact on referrals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The primary care test was changed from RF to anti-CCP antibodies as part of a service development in East and North Devon, UK (population 463\u2009000). Data were monitored post-implementation from 1 March to 31 August 2024. Anti-CCP antibody testing was made available to primary care. General practitioner order communications automatically redirected requests for RF to anti-CCP antibodies. Local referral guidelines were implemented recommending anti-CCP antibodies to support referral decisions but not for rule-out of inflammatory arthritis. The equivalent 6-month period from 2023 when RF was the primary test for inflammatory arthritis was used for comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Positive tests decreased from 10.6% with RF to 3.9% with anti-CCP antibodies. This led to 57 (39%) fewer referrals following a positive test. The false positive rate among those referred to rheumatology decreased from 59% (91\/148) with RF to 32% (29\/91) with anti-CCP antibodies. Anti-CCP antibodies and RF detected similar numbers of inflammatory arthritis cases with a case yield of 2.1% for both tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Replacement of RF with anti-CCP antibodies within a redesigned inflammatory arthritis pathway reduced unnecessary rheumatology referrals. This could help oversubscribed services reduce waiting times and thus contribute to timely diagnosis of inflammatory arthritis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/rap\/rkag103","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:47:05Z","timestamp":1786798025000},"source":"Crossref","is-referenced-by-count":0,"title":["Primary care anti-cyclic citrullinated protein antibody testing for rheumatoid arthritis and accompanying pathway redesign reduces unnecessary referrals"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3246-1680","authenticated-orcid":false,"given":"George F G","family":"Allen","sequence":"first","affiliation":[{"name":"NIHR Exeter Biomedical Research Centre, University of Exeter , Exeter,","place":["UK"]},{"name":"Blood Sciences, Royal Devon University Healthcare NHS Foundation Trust , Exeter,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3559-6660","authenticated-orcid":false,"given":"Timothy J","family":"McDonald","sequence":"additional","affiliation":[{"name":"NIHR Exeter Biomedical Research Centre, University of Exeter , Exeter,","place":["UK"]},{"name":"Blood Sciences, Royal Devon University Healthcare NHS Foundation Trust , Exeter,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2269-7467","authenticated-orcid":false,"given":"Stuart","family":"Kyle","sequence":"additional","affiliation":[{"name":"Rheumatology, Royal Devon University Healthcare NHS Foundation Trust , Barnstaple,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Keysell","sequence":"additional","affiliation":[{"name":"Devon Referral Support Service, NHS Devon , Exeter,","place":["UK"]},{"name":"Clare House Surgery , Tiverton,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"2026090513164722800_rkag103-B1","doi-asserted-by":"crossref","first-page":"797","DOI":"10.7326\/0003-4819-146-11-200706050-00008","article-title":"Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis","volume":"146","author":"Nishimura","year":"2007","journal-title":"Ann Intern Med"},{"key":"2026090513164722800_rkag103-B2","author":"National Institute for Health and Care Excellence","year":"2018"},{"key":"2026090513164722800_rkag103-B3","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1002\/art.27584","article-title":"2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology\/European League Against Rheumatism collaborative initiative","volume":"62","author":"Aletaha","year":"2010","journal-title":"Arthritis 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