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

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...