الفهرس 
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Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that is characterized by pain, inflammation, and joint destruction and affects up to 1.0% of the general population. Early diagnosis and treatment in RA is crucial as it can prevent disease progression and irreversible joint damage. RA diagnosis is based on a combined approach that consists of history acquisition, clinical examination, imaging modalities, and testing of acute phase and serological markers such as rheumatoid factor (RF) and anti citrullinated peptide/protein antibodies (ACPA). Historically, rheumatoid factor (RF) was the main element in the serological diagnosis of RA and the only laboratory diagnostic parameter included in the 1987 American College of Rheumatology (ACR) criteria for the classification of RA. In 1998, the presence of auto antibodies specific to citrulline containing antigens was reported in RA patients. Clinical studies found that ACPA were more specific than RF in diagnosis of RA. Consequently, these serological markers ACPA were included in the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 criteria for diagnosis RA. Anti-citrullinated peptide/protein antibodies are generally detected using anti-cyclic citrullinated peptide (anti-CCP) antibody assays. The first generation of the anti-CCP used antigen peptide derived from the filaggrin protein. But, the third generation anti-CCP detected on peptides specifically designed and optimized (mimotypes) to detect ACPA, with increased sensitivity for detection of RA patients. Therefore, the main objective for the current study was to determine sensitivity and specificity of the third generation anti cyclic citrullinated peptide (anti-CCP 3) antibodies in comparison to that of anti-CCP in diagnosis of Rheumatoid arthritis. The study was recruited on thirty rheumatoid arthritis Patients (group I) diagnosed according to the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 criteria for diagnosis of Rheumatoid arthritis. In addition to fifteen apparently healthy volunteers (group II) matched in age and sex will be studied as controls. All participants were subjected to complete history talking, complete clinical examination and laboratory assessment (CBC, ESR, CRP, RF, renal and liver function testes, anti-CCP and anti-CCP3) Summary of our results: • Most of RA patients were active and had moderate disease activity & moderate functional loss. • All RA patients were on conventional DMARD. • Acute phase reactants (ESR, CRP), RF, Anti-CCP and Anti-CCP3 results had higher sensitivity in RA patients compared to controls. • The sensitivity and specificity of RF in RA patients were 76.67%, and 80% respectively. • The sensitivity and specificity of anti-CCP in RA patients were 76.67% and 87% respectively. • The sensitivity and specificity of anti-CCP3 in RA patients were 83.33%, and 93.33% respectively. • There was a positive significant correlation between anti-CCP and ESR, RF, bone erosions and narrow joint space. • There was a positive significant correlation between anti-CCP3 and ESR, RF, bone erosions and narrow joint space. • Radiological abnormalities of both hands and feet were detected in 27 (90%) patients.