title: 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.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, P,O, Box 23 Vinderen, 0319 Oslo, Norway. maria_mjaavatten@hotmail.com
authors.forename: Maria D
authors.initials: MD
authors.lastname: Mjaavatten
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Till
authors.initials: T
authors.lastname: Uhlig
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Haugen
authors.forename: Halvor
authors.initials: H
authors.lastname: Nygaard
authors.forename: Göran
authors.initials: G
authors.lastname: Sidenvall
authors.forename: Knut
authors.initials: K
authors.lastname: Helgetveit
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
mesh_terms: D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D001168:Arthritis / Q000097:blood / Q000276:immunology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009664:Norway; D010456:Peptides, Cyclic / Q000276:immunology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012217:Rheumatoid Factor / Q000097:blood*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013997:Time Factors; D055815:Young Adult
chemical_list: D000888:Antibodies, Anti-Idiotypic; D007075:Immunoglobulin M; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor
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