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Early identification of rheumatoid arthritis: the risk of overtreatment in perspective
  1. Annette van der Helm-van Mil
  1. Departments of Rheumatology, Leiden University Medical Center and Erasmus Medical Center, Leiden, Rotterdam, The Netherlands
  1. Correspondence to Prof dr Annette van der Helm-van Mil, Department of Rheumatology, Leiden University Medical Center, Leiden and Erasmus Medical Center, Rotterdam, The Netherlands; A.H.M.van_der_Helm{at}lumc.nl

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With interest I read the Viewpoint of Landewé in which he discussed six domains in rheumatology in which progress has been made in the last decennia, and where the occurrence of overdiagnosis and subsequent overtreatment could be a disadvantageous side effect.1 I appreciate and agree with his concerns. Indeed, the burden of unnecessary treatment should be avoided for individual patients and for society as a whole, especially if expensive drugs (eg, biologics) are applied.

The Viewpoint is written from the general concept, referring to advances in rheumatoid arthritis (RA), spondyloarthritis and psoriatic arthritis. With respect to the paradigm ‘early diagnosis’, Landewé included a remark concerning the recent efforts to identify patients at risk for RA in the symptomatic phase that precedes the development of clinically evident arthritis.1 When discussing the risks of overtreatment as a drawback of early identification of RA, it is important to put the discussion in the correct context.

Arthralgia suspicious for progression to RA (or clinically suspect arthralgia, CSA) is …

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