This is Part One of a two-part series on early arthritis clinics.
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Explore This IssueMay 2008
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Early arthritis clinics (EACs) and the huge research databases amassed over the past 20 to 30 years in Europe and other countries have vastly improved physicians’ understanding and treatment of the early stages of rheumatoid arthritis (RA).
The pioneering EACs, many of which are in Europe, were established by rheumatologists seeking an earlier intervention in RA. The EACs were largely responsible for current criteria used to predict persistent RA in early, undifferentiated arthritic patients, and for the advent of new treatments that enhance patient outcomes.
RA patients were first studied in the late 1950s with population-based studies in Bath, U.K., and in the 1960s from cohorts in Middlesex, U.K., and Memphis, Tenn. As a result, research published in the 1980s demonstrated early structural erosion and the long-term consequences of RA. At that time, treatment guidelines for the initial therapy of RA called for nonsteroidal anti-inflammatory drugs, with disease-modifying antirheumatic drugs (DMARDs) prescribed much later, often after early destruction had already occurred.
Although today’s EACs vary in their definition of “early” RA (some restrict selection to patients symptomatic for three or less months, while others allow patients with symptoms for up to two years), they have universally adopted improved diagnostic and imaging techniques—and, most importantly, the use of DMARDs earlier in the course of disease.
Beginnings in Birmingham
One of the first EACs was founded in 1983 at Queen Elizabeth Hospital, Birmingham, U.K., by Paul Bacon, MD, at that time the Arthritis Research Campaign (ARC) professor of rheumatology at the University of Birmingham. His goal was to identify factors to predict which patients with early synovitis would go on to develop RA. The Birmingham clinic had ceased operation in the mid 1980s, but then Paul Emery, MD, arrived and restarted it. Dr. Emery is currently the ARC professor of rheumatology at the University of Leeds, U.K., and director of the Leeds EAC, which he formed in 1994.
The goals of the early EACs were important because “one would like to focus therapy on those patients who are going to develop RA while sparing the half of early arthritis patients who get better spontaneously from the risks of therapy,” says Karim Raza, MD, the current director of the Birmingham EAC, now located at City Hospital Birmingham. “Much of the work carried out in this early arthritis clinic was done in collaboration with Mike Salmon, PhD, and Dr. Emery, who made important contributions in the field of genetic predictors of disease outcome.”