Article Text

Download PDFPDF
Progressive increase in time to referral and persistently severe clinical presentation over the years in autoantibody-negative patients with rheumatoid arthritis in the setting of an early arthritis clinic
  1. Ludovico De Stefano1,2,
  2. Bernardo D’Onofrio1,2,
  3. Garifallia Sakellariou2,3,
  4. Antonio Manzo1,2,
  5. Carlomaurizio Montecucco1,2,
  6. Serena Bugatti1,2
  1. 1 Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  2. 2 Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
  3. 3 Maugeri Clinical Research Institutes IRCCS, Pavia, Italy
  1. Correspondence to Professor Serena Bugatti, Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Prompt identification of patients with rheumatoid arthritis (RA), ideally within a window of opportunity of approximately 12 weeks, increases potential for antirheumatic treatments to dampen the inflammatory process in a milder and more reversible stage of the disease, thus enabling more favourable outcomes.1 Over the past 20 years, strategies aimed at reducing delays in RA referral and treatment have included the widespread diffusion of dedicated early arthritis clinics (EACs),2 as well as the development of more sensitive classification criteria.3 Still, the percentage of patients seen within the window of opportunity apparently remains low,4 and the new RA criteria, heavily weighted on autoantibodies, may have further hindered the recognition and treatment of seronegative patients.5

Here, we analysed changes in the diagnostic delay and clinical presentation of patients with RA admitted to the EAC of the Division of Rheumatology of the San Matteo University Hospital, Pavia, Italy, from its institution in 2005 to 2017. Referral criteria to the EAC have remained stable over the years and include ≥3 swollen joints (SJs), or in case of <3 SJs, a positive squeeze test or morning stiffness >30 min.6 From all patients with early arthritis (N=1553), we selected 668 patients fulfilling at enrolment at least the 1987 American College of Rheumatology (ACR) criteria for RA before December 2010 (n=345, 88.4% also fulfilling the 2010 criteria) and at least the 2010 ACR/European Alliance of Associations for Rheumatology criteria after January 2011 (n=323, 63.5% also fulfilling the 1987 criteria). In …

View Full Text


  • Handling editor Josef S Smolen

  • Contributors LDS and SB conceived the work, contributed to the analysis and interpretation of data, and drafted the manuscript. BD'O and GS contributed to the acquisition of data and revised the manuscript critically. AM contributed to the interpretation of data and revised the manuscript critically for important intellectual content. CM conceived the work and revised the manuscript critically for important intellectual content. All the authors provided final approval of the version to be published.

  • Funding This study was supported in part by funding from the IRCCS Policlinico San Matteo Foundation, Pavia, Italy.

  • Competing interests SB reports grant/research support from Pfizer and personal fees from AbbVie, Bristol Myers Squibb, Eli Lilly, Gilead, Pfizer and Sanofi. CM reports personal fees from AbbVie, Bristol Myers Squibb, Eli Lilly, Gilead, Pfizer, Roche and Sanofi.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.