To accurately determine the transmission accuracy degradation pattern of Rotate Vector (RV) reducers due to wear, a predictive method is proposed that simultaneously considers the initial clearance and wear clearance between the cycloid wheel and the pinwheel. The initial clearance is derived from a comprehensive gear system analysis, considering assembly errors, manufacturing errors and modifications. Building on this, the wear depth of the cycloid wheel tooth profile is numerically simulated using Archard's wear theory, revealing the wear distribution pattern under various operating conditions. A Gaussian regression model is used to predict the maximum wear amount for different operational durations. Based on the predicted wear amount, a multi-body dynamic simulation model incorporating wear clearance was established to analyze the transmission error under varying clearance conditions. Results indicate that the wear depth along the tooth profile initially increases and then decreases. The depth and region of wear along the tooth profile gradually increase with load and output speed, with the impact of load on the wear region being greater than that of output speed. Under the initial clearance condition, the maximum transmission error is 22.91″. As the wear clearance increases, transmission accuracy declines sharply. When the cumulative wear clearance reaches 0.2 mm, the transmission error exceeds the allowable backlash limit. This study provides a theoretical reference for predicting accuracy degradation and guides the manufacturing design of RV reducers.