Anti-CCP: the antibodies in rheumatoid arthritis and what a positive result means
Anti-CCP are antibodies that, according to the NVKC, the Dutch society of clinical chemists, the immune system makes in rheumatoid arthritis, an inflammatory process, against the body's own proteins rich in citrulline; in full they are called antibodies against cyclic citrullinated peptides. According to the NVKC, in rheumatoid arthritis the structure of proteins changes because citrulline is coupled to them. According to the NVKC, the immune system usually makes antibodies to make pathogens harmless, but in rheumatoid arthritis these antibodies lead to disease.
According to the NVKC, when anti-CCP is detected in the blood, this means in almost all cases that the patient has or will develop rheumatoid arthritis. According to the NHG, the Dutch college of general practitioners, half of patients with rheumatoid arthritis have no anti-CCP. Only a blood test shows whether anti-CCP is present.
Star-SHL calls an anti-CCP below 7 IU/ml negative, 7 to 10 IU/ml doubtful and above 10 IU/ml positive. Unilabs uses below 7 kU/l, Certe 0 to 10 [arb'U]/mL and Diagnostiek voor U below 5 U/mL.
Turnaround up to 72 hours, estimate Turnaround: up to 72 hours after your blood draw (estimate).
Anti-CCP are antibodies against the body's own proteins containing citrulline, and according to the NHG these antibodies are associated with rheumatoid arthritis. According to the NVKC, a detected anti-CCP means in almost all cases that the patient has or will develop rheumatoid arthritis.
- Star-SHL calls an anti-CCP below 7 IU/ml negative and above 10 IU/ml positive; Unilabs uses below 7 kU/l, Certe 0 to 10 [arb'U]/mL and Diagnostiek voor U below 5 U/mL.
- According to the NHG, half of patients with rheumatoid arthritis have no anti-CCP, and the NHG therefore calls the test unsuitable as a screening instrument.
- According to the NVKC, anti-CCP can be detectable for some years before rheumatic symptoms arise.
Anti-CCP: what Dutch laboratories use
There is no nationally agreed reference value; this is what individual laboratories publish.
| Laboratory | Group | Reference value (IU/ml) | Relative scale |
|---|---|---|---|
| Star-shl | · Everyone · a limit, not a range · negative | < 7 IU/ml |
7
|
| Star-shl | · Everyone · doubtful | 7–10 IU/ml |
7 10
|
| Star-shl | · Everyone · a limit, not a range · positive | > 10 IU/ml |
10
|
| Unilabs | · Everyone · a limit, not a range | < 7 kU/l kU/l | |
| Certe | · Everyone | 0–10 [arb'U]/mL [arb'U]/mL | |
| Diagnostiek voor U | · Everyone · a limit, not a range | < 5 U/mL U/mL |
Source: Star-shl
Source: Unilabs
Source: Certe
Source: Diagnostiek voor U
Each value as the laboratory itself publishes it, retrieved in 2026.
Anti-CCP: what this test measures
According to the NVKC, the anti-CCP test determines whether and to what extent antibodies against the protein CCP (cyclic citrulline peptide) are present in the blood. The four laboratories each give the result in their own unit: IU/ml at Star-SHL, kU/l at Unilabs, [arb'U]/mL at Certe and U/mL at Diagnostiek voor U. Star-SHL and Certe list FEIA, a fluorescence enzyme immunoassay, as the method, and Unilabs lists ELiA.
Anti-CCP: why this value matters
According to the NVKC, anti-CCP is particularly useful for establishing rheumatoid arthritis at an early stage: sometimes the symptoms are not yet very clear, and the test can then give extra information so that targeted treatment can begin at an early stage. According to the NHG, measuring anti-CCP is a very specific test for rheumatoid arthritis, with a sensitivity between 50 and 70% and a specificity between 95 and 97% in various studies.
Anti-CCP: how the blood test works
- Referral
- No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
- The draw
- A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
- Results
- Turnaround: up to 72 hours after your blood draw (estimate).
- Where
- 650+ draw sites run by independent laboratories across the Netherlands. Draw sites
Anti-CCP: when is testing worthwhile?
According to the NVKC, the anti-CCP test is used as an aid in diagnosing rheumatoid arthritis, and according to the NVKC measuring rheumatoid factor (RF) is also important together with this test. According to the NHG, the test should only be used when there is already a reasonable suspicion of rheumatoid arthritis based on the physical examination, the history (the conversation about the symptoms) and the course of the symptoms. Because referral to a rheumatologist is then on the cards anyway, according to the NHG the anti-CCP test has no place in diagnosing rheumatoid arthritis in general practice.
Anti-CCP: symptoms of a high or low value
Low Levels
According to the NVKC, a negative anti-CCP means that the patient's blood contains no antibodies against CCP, but the patient may still have rheumatoid arthritis. According to the NVKC, in that case a doctor sometimes has a rheumatoid factor test done: in a small number of patients with rheumatism anti-CCP is not detectable while the rheumatoid factor is positive.
High Levels
According to the NVKC, a positive anti-CCP means in almost all cases that the patient has or will develop rheumatoid arthritis. The NHG cites a systematic review by Avouac and colleagues in which anti-CCP was found to predict the future development of rheumatoid arthritis to a high degree, both in healthy people and in patients with undifferentiated arthritis, joint inflammation without a set diagnosis. According to Thuisarts, in rheumatoid arthritis the joints are inflamed, for example in the hands, wrists, feet or ankles, and they become swollen and painful. According to Thuisarts, the stiffness in rheumatoid arthritis is worst in the morning on getting up, or on starting to move again after sitting or lying for a while, and can last a few hours.
Anti-CCP: causes of a low or high value
What raises the value
-
Rheumatoid arthritis
Detected anti-CCP means in almost all cases that the patient has or will develop rheumatoid arthritis.
-
Rheumatoid arthritis that has yet to develop
Anti-CCP can be detectable for some years before rheumatic symptoms arise.
Anti-CCP: lifestyle and this value
Discuss a positive anti-CCP with your GP. According to the NHG, with suspected rheumatoid arthritis the GP refers to the rheumatologist at short notice, for early treatment with DMARDs, disease-modifying antirheumatic drugs. According to Thuisarts, smoking often makes rheumatoid arthritis worse, so that someone with rheumatoid arthritis can get more symptoms and more damage to the joints.
Anti-CCP: frequently asked questions
Is anti-CCP the same as rheumatoid factor?
No, anti-CCP and rheumatoid factor are different antibodies. According to the NHG, rheumatoid factor is an antibody against the Fc fragment of immunoglobulins, while according to the NVKC anti-CCP is directed against the body's own proteins rich in citrulline. According to the NVKC, the rheumatoid factor test is much less specific for rheumatoid arthritis.
Can anti-CCP be positive without symptoms?
Yes, according to the NVKC anti-CCP can be detectable in the blood for some years before rheumatic symptoms arise.
Is anti-CCP suitable as a screening test?
No, according to the NHG the anti-CCP test is unsuitable as a screening instrument, because its sensitivity is relatively low: half of patients with rheumatoid arthritis have no anti-CCP.
Anti-CCP: sources
- Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
- Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
- Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
- Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
- NVKC, Alles over testen: Anti-CCP, allesovertesten.nl, geraadpleegd 2026-10-15 (retrieved 2026) allesovertesten.nl
Results without a doctor's assessment
You receive your values with the unit and reference range. A doctor's assessment is not part of this site. Discuss your results with your GP for explanation and treatment decisions.
Anti-CCP
€52,-