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Changes in the clinical presentation of patients with rheumatoid arthritis from the early 1990s to the years 2010: earlier identification but more severe patient reported outcomes
  1. Wouter P Nieuwenhuis1,
  2. Maarten PT de Wit2,
  3. Annelies Boonen3,
  4. Annette HM van der Helm-van Mil1
  1. 1 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Department of Medical Humanities, VU University, Amsterdam, The Netherlands
  3. 3 Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center and CAPHRI, Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Wouter P Nieuwenhuis, Department of Rheumatology C1-R, Leiden University Medical Center, PO Box 9600, Leiden 2300RC, The Netherlands; W.P.Nieuwenhuis{at}

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The relevance of early identification of rheumatoid arthritis (RA) is acknowledged for several decades. Over time the interpretation of early has changed: in the early 1990s a symptom duration <2 years was considered early. Nowadays earlier identification is recommended,1 some suggest that identification within 12 weeks after symptom onset is optimal. In this study, we evaluated the presentation of RA over the past decennia. We assessed whether patients with RA were recognised earlier and if this affected the phenotype of RA at first presentation. We observed that patients with RA are indeed identified after a shorter symptom duration, that this was paralleled with less severe inflammation at presentation, but paradoxically also with increased severity of patient reported outcomes (PROMs).

All patients in the Leiden Early Arthritis Clinic (EAC) cohort that fulfilled the 2010 European League Against Rheumatism/American College of Rheumatology RA criteria were studied (n=1406).2 ,3 In short, the EAC was started in 1993 and inclusion criteria …

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  • Contributors Study concept and design and drafting of the manuscript: WPN, AHMvdH-vM. Acquisition, analysis or interpretation of data and critical revision of the manuscript for important intellectual content: WPN, MPTdW, AB, AHMvdH-vM. Statistical analysis: WPN.

  • Funding This work was supported by the Dutch Arthritis Foundation and the Netherlands Organization for Health Research and Development (Vidi grant).

  • Competing interests None declared.

  • Ethics approval Medical ethical committee of the Leiden University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.