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The now widely employed CCP2 assay, which detects circulating autoantibodies to a panel of synthetic, cyclic citrullinated peptides, carries a positive predictive value of 0.93 for rheumatoid arthritis (RA) among early undifferentiated arthritis (UA) patients,1 thus providing a cornerstone of recently evolved scoring systems that predict and classify early RA.2 However, approximately 80% of newly presenting UA patients are anti-CCP2-negative3 and a quarter of these evolve into RA within 3 years,1 thus experiencing diagnostic delay. The peptides used in the CCP2 assay do not necessarily correspond to in vivo generated proteins, yet citrullinated antigens of putative pathophysiological relevance have recently been described in association with specific circulating autoantibodies in RA.4 Therefore, we hypothesised that the detection of one or any such autoantibodies, as well as those against filaggrin components of the CCP1 assay,5 IgA or IgM rheumatoid factor (RF), might add to the diagnostic utility of CCP2 testing alone in predicting RA progression among early UA patients.
Consecutive adult UA patients with …
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