Early inflammatory clinics. Experience with early arthritis/back pain clinics.

ABSTRACTThere is a clear need to assess patients presenting with a new onset of inflam-matory peripheral arthritis and/or back pain early. Indeed, the clinical presen-tation of rheumatoid arthritis (RA) is not always characteristic but its early diagnosis is crucial to prevent irrever-sible structural damage. Likewise low back pain is common in the general population but may be related to anky-losing spondylitis (AS) and other axial spondyloarthritis (SpA) in up to 5% of cases. Mounting evidence suggests that early intervention leads to improve outcome both in RA and SpA which has important socioeconomic implica-tions. Early inflammatory clinics (EIC) should therefore be considered in every rheumatology department to facilitate the early assessment and diagnosis of these patients allowing for prompt and targeted therapeutic intervention. In addition the EICs allow for a bet-ter focused follow-up of these patients in appropriate secondary clinics. Since the sustained remission of inflamma-tory and autoimmune diseases such as RA is highly dependent on how early treatment is instigated and its efficacy regularly assessed, there is legitimacy for the EICs. Furthermore, there is a clear research interest in building ear-ly inception cohorts that allow for the characterization of the different dis-ease phenotypes.IntroductionRheumatoid arthritis (RA) progresses to irreversible structural damage of the joints and must therefore be diagnosed and treated early, since the achievement of rapid suppression of inflammation to maximize disease control is critical (1). The prevalence of RA is estimated to be about 0.3 to 1% in most European populations. The annual incidence of early arthritis was recently assessed in the Spanish population and reported as 25 cases for 100,000 inhabitants, with an incidence of 8.3 RA cases for 100,000 (2). The clinical presentation of RA is not always characteristic at onset since various clinical phenotypes including mono and oligoarthritis can be seen. Moreover, the current classifi-cation criteria for RA were developed in established disease and therefore are not often fulfilled in the early stages of the disease. Autoantibodies such as rheumatoid factors and especially an-tibodies directed against citrullinated peptides may be present before the ap-pearance of clinical symptoms of RA and constitute relevant diagnosis tools when present (3, 4). However, they are missing in about 30% of early disease, leading to some misdiagnosed cases of early RA (4) and can also be found in other conditions such as Sjogren’s syndrome (5), psoriatic arthritis (6) or infectious diseases (7). Damage can occur within a few months of disease onset and the “missed” RA patients will then be at high risk of reduced function-al capacity and lower quality of life.Low back pain (LBP) is a common symptom in the general population in developed countries, where two thirds are reported to suffer from LBP at somepoint (8). This is also true for profes-sional athletes where it seems to be more prevalent and related to the level of competition (9). Furthermore, it has been shown that the prevalence of physically disabling LBP is rising sig-nificantly with time (10) and generally declines with greater levels of education and increasing income (11). The preva-lence of ankylosing spondylitis (AS), the prototype of the spondyloarthropa-thies (SpA) is between 0.2 to 1.0% (12). Low back pain may be related to SpA and in particular to ankylosing spond-ylitis (AS) in about 5% of cases (13) and athletes may have rheumatic diseases that may initially mimic sports-related injuries (14). The clinical presentation