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CCP Level and Progression to Rheumatoid Arthritis

Arthritis Care Res; ePub 2018 Dec 20; Ford, et al

Among cyclic citrullinated antibody positive (CCP+) patients without rheumatoid arthritis (RA), risk for progression to RA increased substantially with increasing CCP level, according to a recent study. This study provides further support for close monitoring for development of RA among CCP+ patients and identifying strategies to mitigate this risk. Researchers performed a retrospective cohort study of CCP+ individuals seen at a US tertiary care system between 2009‐2018 who were without RA or other systemic rheumatic disease by medical record review at time of CCP positivity. Progression to classifiable RA was determined through medical record review. They found:

  • 340 CCP+ patients who were without RA or other rheumatic disease at baseline were identified.
  • During 1,047 person‐years of follow‐up, 73 (21.5%) patients developed RA.
  • Risk of progression to RA increased with CCP level, with 46.0% of high level CCP patients progressing to RA by 5 years.
  • Compared to low CCP, medium and high CCP levels were strongly associated with progression to RA, adjusting for age, sex, body mass index, smoking, family history of RA, and rheumatoid factor level.


Ford JA, Allison XL, Marshall AA, et al. Impact of cyclic citrullinated peptide antibody level on progression to rheumatoid arthritis in clinically tested CCP‐positive patients without RA. [Published online ahead of print December 20, 2018]. Arthritis Care Res. doi:10.1002/acr.23820.