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Overdiagnosis and overtreatment in rheumatology: a little caution is in order
  1. Robert B M Landewé1,2
  1. 1 Rheumatology & clinical immunology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
  2. 2 Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
  1. Correspondence to Professor Robert B M Landewé, Amsterdam Rheumatology and Clinical Immunology Center, Amsterdam and Zuyderland Medical Center, Amsterdam 1105 AZ, The Netherlands; landewe{at}


Overdiagnosis is a term coined by experts in cancer screening to point to indolent cancers detected by screening that would have never led to manifest health problems. Overdiagnosis leads to unnecessary medical care (overtreatment), anxiety and cost. In rheumatology overdiagnosis and overtreatment are hardly discussed but likely present. This viewpoint examines how our prevailing views on the management of inflammatory rheumatic diseases may relate to overdiagnosis and overtreatment. Six paradigms of modern rheumatology will be discussed: early diagnosis, intensive treatment, remission, prognosis and risk stratification, evidence-based rheumatology, and precision medicine. It is concluded that, in spite of the enormous progress that they have brought, all paradigms bear the intrinsic dangers of overdiagnosis and overtreatment. So a little caution is in order.

  • early rheumatoid arthritis
  • patient perspective
  • psoriatic arthritis
  • spondyloarthritis
  • treatment

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  • Handling editor Josef S Smolen

  • Contributors The author is fully responsible for the content of this manuscript, for drafting it, revising it and approving it for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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

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