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EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)
  1. B Combe1,
  2. R Landewe2,
  3. C Lukas1,
  4. H D Bolosiu3,
  5. F Breedveld4,
  6. M Dougados5,
  7. P Emery6,
  8. G Ferraccioli7,
  9. J M W Hazes8,
  10. L Klareskog9,
  11. K Machold10,
  12. E Martin-Mola11,
  13. H Nielsen12,
  14. A Silman13,
  15. J Smolen10,
  16. H Yazici14
  1. 1Immuno-Rhumatologie, Lapeyronie Hosp, Montpellier, France
  2. 2Rheumatic diseases, University Hosp, Maastricht, Netherlands
  3. 3Rheumatology and Research Centre, University of Medicine, Cluj-Napoca, Romania
  4. 4Rheumatology, Leiden University Medical Centre, Leiden, Netherlands
  5. 5Rheumatology B, Cochin Hospital, Paris, France
  6. 6Rheumatology, Academic Unit of Musculoskeletal diseases, Leeds, United Kingdom
  7. 7Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
  8. 8Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
  9. 9Rheumatology, Karolinska Hospital, Stockholm, Sweden
  10. 10Internal Medicine III, Medical University, Vienna, Austria
  11. 11Rheumatology, Hospital La Paz, Madrid, Spain
  12. 12Rheumatology Q, University Hospital, Herlev, Denmark
  13. 13ARC Unit, Manchester University, Manchester, United Kingdom
  14. 14Rheumatology, Cerrahpasa Medical Faculty, Istanbul, Turkey
  1. Correspondence to:
    Professor Bernard Combe
    Immuno-Rhumatologie, CHU Lapeyronie – 34295 Montpellier cedex 5, France; b-combe{at}


Objective: To formulate EULAR recommendations for the management of early arthritis.

Methods: In accordance with EULAR’s “standardised operating procedures”, the task force pursued an evidence based approach and an approach based on expert opinion. A steering group comprised of 14 rheumatologists representing 10 European countries. The group defined the focus of the process, the target population, and formulated an operational definition of “management”. Each participant was invited to propose issues of interest regarding the management of early arthritis or early rheumatoid arthritis. Fifteen issues for further research were selected by use of a modified Delphi technique. A systematic literature search was carried out. Evidence was categorised according to usual guidelines. A set of draft recommendations was proposed on the basis of the research questions and the results of the literature search.. The strength of the recommendations was based on the category of evidence and expert opinion.

Results: 15 research questions, covering the entire spectrum of “management of early arthritis”, were formulated for further research; and 284 studies were identified and evaluated. Twelve recommendations for the management of early arthritis were selected and presented with short sentences. The selected statements included recognition of arthritis, referral, diagnosis, prognosis, classification, and treatment of early arthritis (information, education, non-pharmacological interventions, pharmacological treatments, and monitoring of the disease process). On the basis of expert opinion, 11 items were identified as being important for future research.

Conclusions: 12 key recommendations for the management of early arthritis or early rheumatoid arthritis were developed, based on evidence in the literature and expert consensus.

  • ACR, American College of Rheumatology
  • ASPIRE, Active Controlled Study of Patients Receiving Infliximab for Treatment of Rheumatoid Arthritis
  • DAS, disease activity score
  • DMARD, disease modifying antirheumatic drug
  • ESCISIT, European Standing Committee for International Clinical Studies Including Therapeutics
  • EULAR, European League Against Rheumatism
  • RCT, randomised controlled trial
  • TEMPO, Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes
  • TICORA, Tight Control for Rheumatoid Arthritis study
  • TNF, tumour necrosis factor
  • early arthritis
  • rheumatoid arthritis
  • management
  • diagnosis

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  • Published Online First 5 January 2006