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Anti-cyclic citrullinated peptide (CCP) antibodies are very specific for the development of rheumatoid arthritis (RA) in patients with very early synovitis.1 Their predictive value is underscored by their high weighting in an algorithm validated in patients with undifferentiated synovitis of ≤3 months' duration.2 However, using this algorithm, one cannot accurately predict the outcome in 25% of patients and additional predictive markers are needed. We have reported that antibodies against type II collagen were unhelpful in this phase of the disease.3 Several groups have measured anti-modified citrullinated vimentin (MCV) antibodies in patients with RA. In patients with symptoms of >12 months' duration, the specificity and sensitivity of anti-MCV were 95% and 71%, respectively.4 The enhanced sensitivity compared with anti-CCP2 raised the possibility of its clinical utility. Subsequently, in patients with synovitis of >2 years' duration, a specificity …
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