Anti-CCP test: what a positive or negative result means (anti-CCP)
- Updated
- 2026-09-10
- Every number with its source
What anti-CCP is
Anti-CCP antibodies are autoantibodies — immune system proteins that mistakenly attack the body's own tissues, in this case the joint membranes. They are directed against citrullinated proteins: normal proteins whose structure changes during inflammation. The anti-CCP test is most often done together with rheumatoid factor (RF): if both markers are positive, that indicates, per MedlinePlus, that rheumatoid arthritis is likely. If anti-CCP is positive and RF is negative, it may mean an early stage of rheumatoid arthritis or an increased risk of developing it in the future. Anti-CCP is considered a more specific marker than RF, because RF can also arise from other causes. A positive anti-CCP occasionally occurs in Sjögren's syndrome, systemic lupus erythematosus, tuberculosis or chronic lung disease as well. A negative result means that no anti-CCP antibodies were found in the blood, but that does not completely rule out rheumatoid arthritis — further tests may be needed.
How the result is reported
The anti-CCP test is most often reported as a positive or a negative result rather than as a numeric reference range — MedlinePlus does not give specific numeric thresholds. You will find your laboratory's exact scale and its cut-off value on your own result form; for the interpretation of the result, turn to your doctor.
| Result | What it indicates per MedlinePlus | What to keep in mind |
|---|---|---|
| Positive, with a positive rheumatoid factor | Rheumatoid arthritis is likely | The two tests are most often assessed together; the final diagnosis is made by a doctor |
| Positive, with a negative rheumatoid factor | May mean an early stage of rheumatoid arthritis or an increased risk of developing it in the future | Anti-CCP is considered a more specific marker than RF, because RF can also arise from other causes |
| Positive, in other conditions | A positive result occasionally occurs in Sjögren's syndrome, systemic lupus erythematosus, tuberculosis or chronic lung disease as well | So a positive result does not always mean rheumatoid arthritis |
| Negative, with a negative rheumatoid factor | Rheumatoid arthritis is less likely | It is not ruled out completely, especially in an early stage — further tests may be needed if the symptoms persist |
When the test is ordered
- When there is joint pain, especially symmetrical pain — on both sides of the body
- When there is joint stiffness in the morning that lasts longer than half an hour
- When joint swelling, redness or increased tenderness is noticed
- When there is tiredness or a mild fever alongside the joint symptoms
- When rheumatoid arthritis is suspected — most often together with a rheumatoid factor (RF) test
- When rheumatoid factor is negative but the symptoms remain suspicious for an early stage of the disease
How to prepare
- No special preparation is usually needed
- You must tell your doctor about every medicine, vitamin and food supplement you take — some of them may need to be avoided for 8 hours before the test
- Blood is drawn from a vein, usually in the arm
A positive (raised) anti-CCP
A positive anti-CCP together with a positive rheumatoid factor indicates, per MedlinePlus, that rheumatoid arthritis is likely. A positive anti-CCP when RF is negative may mean an early stage of the disease or an increased risk of developing it in the future. Less often, a positive result also occurs with other autoimmune or chronic conditions.
Possible causes of a positive result
- Rheumatoid arthritis — especially together with a positive rheumatoid factor
- An early stage of rheumatoid arthritis, or an increased risk of developing it in the future (when RF is negative)
- Sjögren's syndrome
- Systemic lupus erythematosus
- Tuberculosis
- Chronic lung disease
Symptoms that may accompany a positive result
- Joint pain and swelling
- Morning joint stiffness
- Tiredness
- A mild fever
What to discuss with a doctor after a positive result
- The rheumatoid factor (RF) result together with anti-CCP — they are most often assessed together
- Inflammation markers (CRP, ESR) and a joint examination by a doctor
- How long the symptoms have lasted and what they are like — whether they are symmetrical, how long the stiffness lasts in the morning
- Whether a rheumatologist's assessment is needed to clarify the diagnosis
A negative anti-CCP
A negative anti-CCP result means that no anti-CCP antibodies were found in the blood. Per MedlinePlus, a negative anti-CCP together with a negative rheumatoid factor indicates that rheumatoid arthritis is less likely, but it does not rule it out completely — further tests may be needed, especially if the symptoms persist.
What can lie behind a negative result
- There is no rheumatoid arthritis, or it is unlikely
- An early stage of the disease, when there are not yet enough antibodies — the symptoms need to be monitored and the test repeated
What to discuss with a doctor after a negative result
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Frequently asked questions
›What is the normal anti-CCP level?
The anti-CCP test is most often reported as a positive or a negative result rather than as a numeric reference range — MedlinePlus does not give specific numeric thresholds. You will find your laboratory's exact scale and cut-off value on your result form; for the interpretation of the result, turn to your doctor.
›How does anti-CCP differ from rheumatoid factor (RF)?
Both tests are used when rheumatoid arthritis is suspected, but anti-CCP is considered more specific. Per MedlinePlus, if anti-CCP is positive and RF is negative, that may mean an early stage of rheumatoid arthritis or an increased risk of developing it in the future. The two tests are most often assessed together.
›Does a positive anti-CCP always mean rheumatoid arthritis?
Not always. A positive anti-CCP together with a positive RF indicates that rheumatoid arthritis is likely, but a positive result occasionally occurs in Sjögren's syndrome, systemic lupus erythematosus, tuberculosis or chronic lung disease as well. The final diagnosis is made by a doctor.
›Does a negative anti-CCP rule out rheumatoid arthritis?
Not completely. Per MedlinePlus, a negative anti-CCP together with a negative rheumatoid factor indicates that rheumatoid arthritis is less likely, but it does not remove the possibility, especially in an early stage. If the symptoms (joint pain, stiffness) persist, a doctor may order further tests.
›When is an anti-CCP test ordered?
The test is most often ordered when there is joint pain, swelling, morning stiffness, tiredness or a mild fever — symptoms typical of rheumatoid arthritis. It helps a doctor to confirm or rule out the diagnosis, most often together with a rheumatoid factor test.
›Do you need any special preparation before an anti-CCP test?
No special preparation is usually needed, but you must tell your doctor about every medicine, vitamin and supplement you take — some of them may need to be avoided for 8 hours before the test. Blood is drawn from a vein.
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This site is not an emergency service. If severe chest or head pain, breathlessness, confusion, difficulty speaking, heavy bleeding or another acute problem has come on suddenly — do not wait for tests, call 112.
This information is not a diagnosis and does not replace a consultation with a doctor. Reference ranges depend on the laboratory, your age and sex — always compare your result with the range printed on your own report.