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In the study, which was based on a large number of patients, we investigated the time between symptom onset and diagnosis during the last 10 years. Our analysis was presented at the European League Against Rheumatism 2013 before a large audience and subsequently the paper was scrutinised by three independent reviewers, who had no comments on the choice of method. In the paper, and in the subsequent letter, we discussed and acknowledged a number of potential methodological challenges in an observational setting like this, including the risk of right censorship.2 ,3 Based on your comments, however, we acknowledge that this bias arising from patients who have symptoms, but not yet have been diagnosed and, therefore, not included in the data set, may have a larger impact than we understood at the time when the paper was written.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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