Anti-CCP antibodies are very specific for the development of RA in patients with very early synovitis. Their predictive value is underscored by their high weighting in an algorithm validated in patients with undifferentiated synovitis ≤ 3 months duration. However, using this algorithm, one cannot accurately predict 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 disease. Several groups have measured anti-modified citrullinated vimentin (MCV) antibodies in RA patients. In patients with symptoms of < 12 months’ duration, the specificity and sensitivity of anti-MCV were 95% and 71% respectively. The enhanced sensitivity, compared with anti-CCP2, raised the possibility of clinical utility. Subsequently, in patients with synovitis of < 2 years duration, a specificity and sensitivity of 83% and 62% (vs 93% and 57% for anti-CCP2 respectively) has been reported .