Test Catalog

Test Id : RAPAN

Rheumatoid Arthritis Panel, Serum

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluating patients suspected of having rheumatoid arthritis (RA)


Differentiating RA from other inflammatory arthritis or connective tissue diseases


Diagnosis and stratification of rheumatoid arthritis

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

Test Id Reporting Name Available Separately Always Performed
CCP Cyclic Citrullinated Peptide Ab, S Yes Yes
RHUT Rheumatoid Factor, S Yes Yes

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

CCP: Enzyme-Linked Immunosorbent Assay (ELISA)

RHUT: Turbidimetry

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.


Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Rheumatoid Arthritis Panel, S

Lists additional common names for a test, as an aid in searching

Anti Citrullinated Antibody

Anti Citrulline

Anti-CCP (Cyclic Citrullinated Peptide)

Anti-Citrullinated Ab

Anti-Citrullinated Antibody

Anti-Citrulline Antibody

Anti-Cyclic Citrullinated Peptide (CCP)

CCP (Cyclic Citrullinated Peptide)

Citrullinated Ab

Citrullinated Antibody

RA (Rheumatoid Arthritis) Factor

RF (Rheumatoid Factor)

Rheumatoid Arthritis

Specimen Type
Describes the specimen type validated for testing


Ordering Guidance

This test is the optimal first-line antibody panel for evaluating patients at-risk for rheumatoid arthritis.

The following testing may also be useful:

ENAE / Antibody to Extractable Nuclear Antigen Evaluation, Serum

ADNAR / DNA Double-Stranded (dsDNA) Antibodies with Reflex, IgG, Serum

NAIFA / Antinuclear Antibodies, HEp-2 Substrate, IgG, Serum

CTDC / Connective Tissue Diseases Cascade, Serum

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 2 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

1.2 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus OK
Heat-treated specimen Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
Frozen 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluating patients suspected of having rheumatoid arthritis (RA)


Differentiating RA from other inflammatory arthritis or connective tissue diseases


Diagnosis and stratification of rheumatoid arthritis

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by interactions between the environment, specific genetic risk factors, and the human immune system. It affects about 0.6% of the United States population with a global prevalence of 0.24%.(1) Clinically, RA is typified by progressive damage of synovial joints, inflammation, production of diverse autoantibodies, and variable extra-articular manifestations.(2-4) To facilitate early diagnosis, the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria recommend testing for rheumatoid factors (RF) and anticitrullinated protein antibodies (ACPA).(2) RF are autoantibodies directed against the Fc portion of immunoglobulin, while ACPA are directed against peptides and proteins containing citrulline, a modified form of the amino acid arginine.(5,6)


RF is a heterogeneous group of autoantibodies and can be found in other inflammatory rheumatic and nonrheumatic conditions with increased prevalence in healthy individuals 60 years of age and older. More than 75% of patients with RA have an IgM antibody to RF. The titer of RF correlates poorly with disease activity, but those patients with high titers tend to have more severe disease and, thus, a poorer prognosis than seronegative patients. Compared to early serologic tests for RA, including RF, several studies have demonstrated that ACPA have much improved specificity for RA.(4,5,7) A systemic review and meta-analysis of 33 studies, including patients with RA and healthy or disease controls, demonstrated the sensitivity of anti-mutated citrullinated vimentin, anticyclic citrullinated peptide, and RF of 71%, 71%, 77%, with the specificity of 89%, 95%, 73%, and the area under the curve of the summary receiver operating characteristic of 89%, 95%, 82%, respectively.(7) Based on these studies, there exist a subset of patients with RA who are negative for RF and ACPA IgG (seronegative) who must be diagnosed clinically or with use of emerging diagnostic tests.(4,6,8)


In addition to the use of RF and ACPA IgG to diagnose RA, RF and ACPA isotype antibodies and other serologic biomarkers have been used to predict if, and when, an individual who has inflammatory arthritis (IA) may develop future clinically apparent IA and assess genetic and environmental risks.(3,4,8,9)  Furthermore, patients with RA may be categorized based on the phase of disease (early versus established), presence or absence of antibodies (seropositive versus seronegative), clinical manifestations (joint erosion, interstitial lung disease, or cardiovascular), or specific risks (genes, sex, or smoking).(2-4) Delayed diagnosis of RA is associated with joint erosion, destruction or deformities, poor response to treatment with ultimate increase in morbidity, and mortality.(3,4) Although late RA prognosis may be linked to adverse consequences, early diagnosis has been reported to improve outcomes; notably reduced joint destruction or deformity, delayed radiologic progression, and decreased functional disability.(3,4,10)


For more information see Connective Tissue Disease Cascade.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Cyclic Citrullinated Peptide Antibodies, IgG

<20.0 U (negative)

20.0-39.9 U (weak positive)

40.0-59.9 U (positive)

> or =60.0 U (strong positive)

Reference values apply to all ages.


Rheumatoid Factor

<15 IU/mL

Provides information to assist in interpretation of the test results

Cyclic Citrullinated Peptide Antibodies:

A positive result for cyclic citrullinated peptide (CCP) antibodies may be suggestive of rheumatoid arthritis (RA) if compatible clinical features of disease are present.


Significantly elevated levels of CCP antibodies may be useful to identify RA patients with erosive joint disease.


A Mayo Clinic prospective clinical evaluation of the CCP antibody test showed a diagnostic sensitivity for RA of 78% with fewer than 5% false-positive results in healthy controls (see Cautions).


Rheumatoid Factor:

Positive results may be suggestive of RA if compatible clinical features of disease are present.

Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Cyclic Citrullinated Peptide Antibodies:

Positive results for cyclic citrullinated peptide (CCP) antibodies may occur in some patients with systemic lupus erythematosus or other autoimmune, connective tissue diseases. In a Mayo Clinic study (see Interpretation), the false-positive rate in this subgroup was approximately 10%.


Antirheumatic therapy should not be initiated based solely on a positive test for CCP antibodies, and changes in treatment should not be based upon the levels of CCP antibodies.


Rheumatoid Factor:

The presence of rheumatoid factor (RF) antibodies is not specific to rheumatoid arthritis. Antibodies may be found in other systemic autoimmune rheumatic diseases as well as nonrheumatic conditions, including infectious diseases. These diseases include Sjogren syndrome, mixed connective tissue disease, systemic lupus erythematosus, polymyositis, tuberculosis, syphilis, viral hepatitis, infectious mononucleosis, and influenza. RF antibodies have been observed in nonaffected individuals, particularly in patients 60 years of age or older.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Cross M, Smith E, Hoy D, et al: The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014 Jul;73(7):1316-1322

2. Aletaha D, Neogi T, Silman AJ, et al: 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010 Sep;62(9):2569-2581

3. Burgers LE, Raza K, van der Helm-van Mil AH: Window of opportunity in rheumatoid arthritis - definitions and supporting evidence: from old to new perspectives. RMD Open. 2019 Apr 3;5(1):e000870

4. Deane KD, Holers VM: Rheumatoid arthritis pathogenesis, prediction, and prevention: An emerging paradigm shift. Arthritis Rheumatol. 2021 Feb;73(2):181-193

5. Schellekens GA, Visser H, de Jong BA, et al: The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Arthritis Rheum. 2000 Jan;43(1):155-163

6. Derksen VFAM, Huizinga TWJ, van der Woude D: The role of autoantibodies in the pathophysiology of rheumatoid arthritis. Semin Immunopathol. 2017 Jun;39(4):437-446

7. Zhu JN, Nie LY, Lu XY, Wu HX: Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria? Clin Chem Lab Med. 2019 Oct 25;57(11):1668-1679

8. Verheul MK, Bohringer S, van Delft MAM, et al: Triple positivity for anti-citrullinated protein autoantibodies, rheumatoid factor, and anti-carbamylated protein antibodies conferring high specificity for rheumatoid arthritis: Implications for very early identification of at-risk individuals. Arthritis Rheumatol. 2018 Nov;70(11):1721-1731

9. Hedstrom AK, Ronnelid J, Klareskog L, Alfredsson L: Complex relationships of smoking, HLA-DRB1 genes, and serologic profiles in patients with early rheumatoid arthritis: Update from a Swedish population-based case-control study. Arthritis Rheumatol. 2019 Sep;71(9):1504-1511

10. Emery P, Breedveld FC, Dougados M, Kalden JR, Schiff MH, Smolen JS: Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis. 2002 Apr;61(4):290-297

11. Cush JJ: Rheumatoid arthritis: Early diagnosis and treatment. Rheum Dis Clin North Am. 2022 May;48(2):537-547

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Description
Describes how the test is performed and provides a method-specific reference

Cyclic Citrullinated Peptide Antibodies:

Cyclic citrullinated peptide (CCP) antibodies in serum are detected by binding to the wells of a commercial microtiter plate coated with synthetic CCP. During the first incubation, serum antibodies bind to adsorbed, solid phase CCP. The wells are then washed to remove unbound serum constituents, and horseradish peroxidase-labeled goat anti-human IgG is added. After further incubation and washing to remove unbound conjugate, substrate (3,3',5,5' tetramethylbenzidine) is added, and the mixture incubated. The reaction between enzyme and substrate is stopped, and color in the wells measured in a microtiter plate reader. The concentration of CCP antibodies is determined by comparison to a 5-point standard curve (15.6-250 U). Testing is performed on the Agility instrument by Dynex.(Package insert: Quanta Lite CCP3 IgG ELISA. INOVA Diagnostics; 02/2020)


Rheumatoid Factor:

The Roche rheumatoid factors (RF-II) assay is an immunoturbidimetric assay. Latex-bound heat-inactivated IgG (antigen) reacts with the rheumatoid factor (RF) antibodies in the sample to form antigen/antibody complexes that, following agglutination, are measured turbidimetrically. Rheumatoid factors are autoantibodies that are directed against the Fc fragment of IgG. The autoantibodies occur in all immunoglobulin classes (IgA, IgG, and IgM). The Roche RF II assay measures all 3 types of autoantibodies. However, as the IgA and IgG types typically exhibit lower concentrations, the reaction against IgM autoantibodies predominates in this assay.(Package insert: RF-II, Rheumatoid Factors II. Roche Diagnostics; V 9.0 English, 02/2020)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information


Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Saturday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 3 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test


Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.



LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
RAPAN Rheumatoid Arthritis Panel, S 46437-0
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
CCP Cyclic Citrullinated Peptide Ab, S 33935-8
RHUT Rheumatoid Factor, S 11572-5

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports

Test Update Resources

Change Type Effective Date
New Test 2023-04-06
New Test 2023-04-06