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Positive anti-citrullinated protein antibody status and small joint arthritis are consistent predictors of chronic disease in patients with very early arthritis: results from the NOR-VEAC cohort

Maria D Mjaavatten1*, Till Uhlig1, Anne J Haugen2, Halvor Nygaard3, Göran Sidenvall4, Knut Helgetveit5 and Tore K Kvien1

Author Affiliations

1 Department of Rheumatology, Diakonhjemmet Hospital, P.O. box 23 Vinderen, 0319 Oslo, Norway

2 Department of Rheumatology, Østfold Hospital Trust, 1603 Fredrikstad, Norway

3 Lillehammer Hospital for Rheumatic Diseases, Margrethe Grundtvigs vei 6, 2609 Lillehammer, Norway

4 Department of Rheumatology, Innlandet Hospital, 2226 Kongsvinger, Norway

5 Martina Hansen Hospital, P.O. box 23, 1306 Bærum Postal Terminal, Norway

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Arthritis Research & Therapy 2009, 11:R146  doi:10.1186/ar2820

Published: 1 October 2009



The current 1987 American College of Rheumatology (ACR) classification criteria for rheumatoid arthritis (RA) have proven less useful in early arthritis. The objective of this study was to identify and compare predictors of three relevant outcomes of chronic arthritis in a cohort of very early arthritis patients.


The Norwegian Very Early Arthritis Cohort (NOR-VEAC) includes adult patients with at least one swollen joint of ≤16 weeks' duration. Patients are followed for 2 years with comprehensive clinical and laboratory examinations. Logistic regression analyses were performed to determine independent predictors of three outcomes: persistent synovitis, prescription of disease-modifying anti-rheumatic drugs (DMARDs), and established clinical RA diagnosis within one year.


Of 384 patients eligible for one year follow-up (56.3% females, mean (SD) age 45.8 (14.7) years, median (IQR) duration of arthritis 31 (10-62) days), 14.4% were anti-CCP2 positive, and 11.2% were IgM RF positive. 98 patients (25.5%) had persistent synovitis, 106 (27.6%) had received DMARD treatment during follow-up, while 68 (17.7%) were diagnosed with RA. Consistent independent predictors across all three outcomes were positive anti-citrullinated protein antibody (ACPA) status (odds ratio (OR) 3.2, 5.6 and 19.3), respectively, and small joint arthritis (proximal interphalangeal joint (PIP), metacarpo-phalangeal joint (MCP), and/or metatarso-phalangeal joint (MTP) joint swelling) (OR 1.9, 3.5, and 3.5, respectively).


Positive ACPA status and small joint arthritis were consistent predictors of three relevant outcomes of chronic arthritis in very early arthritis patients. This consistency supports DMARD prescription as a valid surrogate endpoint for chronic arthritis. Importantly, this surrogate is used in ongoing efforts to develop new diagnostic criteria for early RA.