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Open Access Research article

The likelihood of persistent arthritis increases with the level of anti-citrullinated peptide antibody and immunoglobulin M rheumatoid factor: a longitudinal study of 376 patients with very early undifferentiated arthritis

Maria D Mjaavatten1*, Désirée van der Heijde12, Till Uhlig1, Anne J Haugen3, Halvor Nygaard4, Göran Sidenvall5, Knut Helgetveit6 and Tore K Kvien1

Author Affiliations

1 Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen, 0319 Oslo, Norway

2 Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, Leiden, P.O. Box 9600, 2300RC, The Netherlands

3 Department of Rheumatology, Østfold Hospital Trust, 1603 Fredrikstad, Norway

4 Lillehammer Hospital for Rheumatic Diseases, Margrethe Grundtvigs vei 6, 2609 Lillehammer, Norway

5 Department of Rheumatology, Innlandet Hospital, 2226 Kongsvinger, Norway

6 Martina Hansen Hospital, P.O. Box 23, 1306 Bærum Postal Terminal, Norway

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Arthritis Research & Therapy 2010, 12:R76  doi:10.1186/ar2995

Published: 5 May 2010

Abstract

Introduction

We wanted to assess the importance of the levels of anti-citrullinated peptide antibody (anti-CCP) and immunoglobulin M (IgM) rheumatoid factor (RF) in predicting development of persistent arthritis from undifferentiated arthritis (UA), and to investigate whether there is an added predictive value for persistent arthritis in testing for both anti-CCP and IgM RF.

Methods

Patients with UA (exclusion of definite non-rheumatoid arthritis (RA) diagnoses) included in the Norwegian very early arthritis clinic were assessed for development of persistent arthritic disease. The effect of antibody level on the likelihood of persistent arthritis was investigated, and the sensitivity and specificity for persistent arthritis for anti-CCP and IgM RF, separately and combined, was determined.

Results

A total of 376 UA patients were included (median arthritis duration 32 days). 59 (15.7%) patients were IgM RF positive, and 62 (16.5%) anti-CCP positive. One hundred, seventy-four (46.3%) had persistent disease after one year. Overlap of anti-CCP and IgM RF positivity was 58%. Sensitivity/specificity for persistent arthritis was 28/95% for IgM RF alone, 30/95% for anti-CCP alone, and 37/92% for positivity of both anti-CCP and IgM RF. The likelihood for persistent disease increased with increasing levels of both anti-CCP and IgM RF.

Conclusions

The likelihood of developing persistent arthritis in UA patients increases with the level of anti-CCP and IgM RF. Testing both anti-CCP and IgM RF has added predictive value in UA patients. This study suggests that antibody level should be taken into account when making risk assessments in patients with UA.