A multivariable prediction model to identify anti-CCP positive people in those with non-specific musculoskeletal symptoms in primary care
Authors' conclusion
Targeted anti-CCP testing in primary care may aid earlier identification of people at risk of RA, prompting specialist referral to rheumatology for earlier diagnosis and initiation of disease-modifying therapy.
Study context
- Population
- People aged ≥16 years presenting to primary care with new-onset non-specific musculoskeletal symptoms and no history of clinical synovitis203 (2.95%) anti-CCP positive
- Participants
- 6,879 people
- Comparison
- Model-recommended anti-CCP testing vs below threshold
- Above thresholdn = 1,288
- Below thresholdn = 5,591reference
- Outcome
- Anti-CCP positivity (model discrimination by AUROC)
Methodological detailsLASSO-penalized logistic regression, bootstrapping and cross-validation, decision curve analysis, 12-month follow-up
- LASSO-penalized logistic regression
- Bootstrapping and cross-validation
- Decision curve analysis
- 12-month follow-up
Performance
As reported in the abstract
Anti-CCP positivity
- AUROC
- 0.65 (95% CI 0.61, 0.69, optimism = 0.03)
- Net benefit
- 0.0040 (0.0020 corrected)
Further findings
- Inflammatory arthritis/RA diagnosis · 12 months — Below threshold
- 0.3%
- Inflammatory arthritis/RA diagnosis — Participants diagnosed with inflammatory arthritis/RA
- 48
- Inflammatory arthritis/RA diagnosis: Above threshold, anti-CCP positive 32.1%
- Inflammatory arthritis/RA diagnosis: Anti-CCP negative 0.4%
Original publication
A multivariable prediction model to identify anti-CCP positive people in those with non-specific musculoskeletal symptoms in primary care. Rheumatology (Oxford). Published 4 December 2024. doi:10.
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