Progression from symptom onset to rheumatoid arthritis: is the trajectory similar in anticitrullinated protein antibody-positive and -negative disease? A comparative longitudinal study
Authors' conclusion
From symptom onset to RA development, ACPA-negative and ACPA-positive disease differ in timelines, morning stiffness severity, and location of inflammation in hands/feet.
Study context
- Population
- Patients with clinically suspected arthralgia (CSA) who all developed rheumatoid arthritis (RA)
- Participants
- 173 patients
- Exposure
- Anticitrullinated protein antibody (ACPA)-positive vs ACPA-negative developing RA
- ACPA-positiven = 86
- ACPA-negativen = 87reference
- Outcome
- Time from symptom onset to CSA presentation and from CSA presentation to RA development
Main finding
As reported in the abstract
Timelines from symptom onset to RA
- Longer time from symptom onset to CSA presentation in ACPA-positive
- p = 0.006
- Shorter time from CSA presentation to RA development in ACPA-positive
- p = 0.014
Observational data: associations, not effects.
Further findings
Morning stiffness
- More in ACPA-negative at symptom onset
- P = 0.024
- More in ACPA-negative at CSA presentation
- P = 0.006
- More in ACPA-negative until RA development
- P = 0.017
Hand pain and tender hand joints
- More tender hand joints in ACPA-negative at CSA presentation
- P < 0.001
- More tender hand joints in ACPA-negative until RA development
- P < 0.001
- More hand pain in ACPA-negative at symptom onset
CRP and subclinical joint inflammation (MRI), year before RA · the year before developing RA
- Faster increase in CRP in ACPA-positive
- P = 0.006
- Greater increase in forefoot inflammation in ACPA-positive
- P = 0.043
Original publication
Progression from symptom onset to rheumatoid arthritis: is the trajectory similar in anticitrullinated protein antibody-positive and -negative disease? A comparative longitudinal study. Ann Rheum Dis. Published 27 May 2026. doi:10.
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