Ann Rheum Dis 63:1090-1095 doi:10.1136/ard.2003.014233
  • Extended report

Prediction of radiological outcome in early rheumatoid arthritis in clinical practice: role of antibodies to citrullinated peptides (anti-CCP)

  1. K Forslind1,
  2. M Ahlmén2,
  3. K Eberhardt3,
  4. I Hafström4,
  5. B Svensson1,
  6. for the BARFOT study group
  1. 1Section of Rheumatology, Helsingborgs lasarett, Helsingborg, Sweden
  2. 2Rheumatology Department, Sahlgrenska University Hospital, Mölndal, Sweden
  3. 3Rheumatology Department, University Hospital, Lund, Sweden
  4. 4Rheumatology Department, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden
  1. Correspondence to:
    Dr B Svensson
    Blistorpsvägen 105, 290 38 Villands Vånga, Sweden;
  • Accepted 17 October 2003


Objective: To investigate the role of anti-cyclic citrullinated peptide antibody (anti-CCP) for the prediction of radiological outcome in patients with early rheumatoid arthritis.

Methods: Anti-CCP was assessed at baseline in 379 patients with early rheumatoid arthritis (disease duration <1 year). Radiological joint damage and progression were assessed by Larsen score after two years of follow up (end point) and used as outcome variables. The prognostic value of anti-CCP and other demographic and disease related baseline variables were assessed by univariate and multivariate analyses, including calculation of odds ratios (OR), predictive values, and multiple logistic regression models.

Results: The presence of anti-CCP was associated with significantly higher Larsen score both at baseline and at end point. Univariate predictor analysis showed that anti-CCP had the highest significant OR for radiological joint damage and progression after baseline Larsen score, followed by rheumatoid factor, erythrocyte sedimentation rate (ESR), C reactive protein, age, smoking status, and sex. In stepwise multiple regression analyses, baseline Larsen score, anti-CCP, and ESR were selected as significant independent predictors of the radiological outcomes.

Conclusions: There is good evidence for an association of anti-CCP with radiological joint changes in rheumatoid arthritis. Anti-CCP is an independent predictor of radiological damage and progression. Though prediction in early rheumatoid arthritis is still far from perfect, the use of anti-CCP in clinical practice should make it easier for rheumatologists to reach judicious treatment decisions.