Early Arthritis Screening Boosts Long-Term Outcomes

IN PATIENTS with rheumatoid arthritis, screening via a dedicated early arthritis recognition clinic was linked to lower long-term disease activity, less disability, and higher rates of drug-free remission compared with standard referral pathways, according to a new Dutch cohort study.

Arthritis Screening to Reduce GP Referral Delay

GP delay has been recognised as the main cause of referral delay for rheumatoid arthritis in the Netherlands, largely due to insufficient experience with joint examination. This delay led to the launch of the early arthritis recognition clinic, where rheumatologists screen patients directly for clinical arthritis, though the long-term effectiveness of this approach has remained unknown.

Comparative Cohort Study at the Leiden Early Arthritis Clinic

Researchers conducted a single-centre, longitudinal, comparative effectiveness cohort study comparing patients with rheumatoid arthritis referred through the early arthritis recognition clinic (recruited 2010-2020) with similar patients referred through regular routes (recruited 2006-2009). Both groups received similar treatment and five years of follow-up at the Leiden Early Arthritis Clinic.

Disease Activity Score and functional disability, measured using the Health Assessment Questionnaire-Disability Index, were analysed using a linear mixed model, while sustained DMARD-free remission was analysed using Cox regression.

Screening Clinic Linked to Better Outcomes and Shorter Delays

Of 2,081 patients seen via the early arthritis recognition clinic pathway, 818 had clinical arthritis and 122 with rheumatoid arthritis were included in the study (59% female). Of 690 patients referred via the regular pathway, 342 with rheumatoid arthritis were included (66% female).

Patients referred via the early arthritis recognition clinic had lower disease activity over five years (β=0.26, 95% CI 0.12 to 0.41, p=0.0003), less functional disability over five years (β=0.14, 95% CI 0.02 to 0.25, p=0.021), and higher rates of sustained drug-free remission (hazard ratio 2.1, 95% CI 1.34 to 3.16, p=0.0010) compared with regularly referred patients. Patients identified via the early arthritis recognition clinic also had a shorter median GP delay than regularly referred patients (5.14 weeks, IQR 1.86 to 11.43, versus 9.00 weeks, IQR 5.00 to 20.14, p<0.0001).

Implications for Early Detection Pathways in Rheumatoid Arthritis

These findings have suggested that implementing an early arthritis recognition clinic improved long-term outcomes and reduced referral delays for patients with rheumatoid arthritis. As this was a non-randomised comparison between two historical cohorts, causality cannot be fully established. The authors have noted this is among the first studies to indicate that active intervention to accelerate diagnosis appears effective in improving long-term outcomes.

Reference

van Griethuysen SR et al. Long-term effectiveness of the Early Arthritis Recognition Clinic’s screening for the presence of clinical arthritis in the Netherlands: a single-centre, longitudinal cohort study. Lancet Rheumatol. 2026;DOI:10.1016/S2665-9913(26)00114-1.

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