GLASGOW, Scotland — People with musculoskeletal symptoms who test positive for anticyclic citrullinated peptide antibodies (CPP+) but do not have joint inflammation seem less likely to develop rheumatoid arthritis (RA) in the future if they have at least one of several “good” prognostic factors, based on findings from a cohort study.

No tenosynovitis, low anti-CCP positivity, a normal erythrocyte sedimentation rate (ESR), and no more than one tender joint were found to be significantly predictive for not having a diagnosis of RA at both 5 and 10 years. Rheumatoid factor (RF) negativity was also predictive of nonprogression to RA at 5 years.

“In particular, we found that patients who had all of these good prognosis factors at baseline did not progress to inflammatory arthritis at both 5 and 10 years, respectively,” 

Sana Sharrack, MB BChir, reported at the British Society for Rheumatology (BSR) 2026 Annual Meeting.

Sharrack, a senior rheumatology registrar and clinical doctoral fellow working at the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds in Leeds, England, presented findings from the Leeds Coordinated Program to Prevent Arthritis study during one of the oral abstract sessions at the meeting.

The Leeds CCP study

The Leeds CCP study is a national, prospective, observational cohort study designed to identify people with RA at a preclinical stage. As such, it enrolls people who are CCP+ with new-onset, nonspecific musculoskeletal symptoms but no clinical synovitis. This population is deemed at risk of developing RA in the future, according to Sharrack. “Many of these individuals are referred from primary care colleagues to secondary care,” she noted.

Although high-risk individuals (those who have clinical synovitis) should be identified and considered for preventive intervention, “many CCP+ at-risk individuals have a low absolute risk of developing rheumatoid arthritis and could therefore be reassured, educated, and monitored in a community setting,” Sharrack said.

She presented data from an analysis aiming to determine baseline characteristics that may be associated with a good prognosis, meaning no progression to RA at either 5 or 10 years after presentation.

Factors Associated With Nonprogression

Results showed that 317 (70%) of 450 individuals with 5 years’ follow-up data and 73 (46%) of 157 with 10 years’ worth of data had not progressed to RA.

Multivariable logistic regression analyses showed the following five factors were independently associated with nonprogression to RA at 5 years:

• Normal ESR (odds ratio [OR], 6.44)
• RF negativity (OR, 4.35)
• No tenosynovitis on an ultrasound scan at baseline (OR, 3.23)
• Low anti-CCP antibody titer, defined as a value that was less than three times the upper limit of normal (OR, 3.15)
• No more than one tender joint at baseline (OR, 1.08)

All but RF negativity were also independently positively associated with the absence of arthritis at 10 years, particularly for no tenosynovitis at baseline (OR, 50.00) and a low anti-CCP antibody level (OR, 38.89). Having a normal ESR (OR, 3.85) and no more than one tender joint at baseline (OR, 1.33) were also significant predictors for not having a diagnosis of RA at 10 years.

Good Prognosis Factors Add Up

Data also showed that the greater the number of good prognosis factors, the more likely the participant was to be arthritis-free at both 5 and 10 years.

The percentage of arthritis-free individuals at 5 years who had 0, 1, 2, 3, 4, and 5 good prognosis factors at baseline were a respective 29%, 41%, 64%, 82%, 92%, and 100% (P < .001).

The percentage of arthritis-free individuals at 10 years with 0, 1, 2, 3, and 4 good prognosis factors at baseline were a respective 21%, 32%, 50%, 90%, and 100% (P < .001).

“We think these data could be used to inform community-based management strategies for low-risk individuals and streamline referrals to secondary care, with those identified as having three or more of these baseline good prognosis factors being considered first for this approach,” Sharrack concluded.

One delegate raised “a slightly more philosophical question” about whether making a diagnosis of RA was important in this patient population: “You’ve got some symptomatic [people], CCP+, raised inflammatory markers, and maybe a bit of synovitis on an ultrasound scan. Does it really matter whether we call them as having rheumatoid arthritis or not? Because I guess a lot of us would probably treat in that scenario.”

Sharrack said it was an important question, and treatment in that cohort of individuals was not uniform across rheumatology.

“What we found in our research cohorts is that subclinical synovitis, even in those at risk, can disappear within 12 months in about 50% of individuals,” she said.

In the absence of clinical synovitis, the risk cannot be predicted, she acknowledged, adding that “there are individuals who have subclinical synovitis at baseline who have not progressed. So there’s an argument to say, maybe hold off.”

Conversely, she noted that there were “a large number of individuals who develop some clinical synovitis” and may need to be treated.

The study was independently supported. Sharrack reported receiving a National Institute for Health and Care Research Leeds BRC Doctoral Fellowship. She reported having no relevant financial relationships.

Sara Freeman is a medical journalist based in London, England.