The first Birmingham EAC recruited patients with symptoms up to six months’ duration by actively approaching and encouraging primary care physicians to refer appropriate patients. Today’s Birmingham EAC has changed its focus to patients with symptom duration of three months or less.
“The great successes of our early arthritic clinics have been that we have been able to identify very specific predictors of the development of RA in patients with early synovitis and have identified, for the first time, that the first few weeks after the onset of symptoms represent a pathologically distinct phase in the development of RA,” says Dr. Raza.
For example, the Birmingham group noted that a combination of anti-cyclic citrullinated peptide (CCP) antibodies and rheumatoid factor in patients with three months’ or less symptom duration has a high specificity for development of persistent RA.1 These findings were later validated by the Austrian group led by Josef S. Smolen, MD, chair of the division of rheumatology at the Medical University of Vienna in Austria and chair of the second department of medicine at the Center for Rheumatic Diseases at Hietzing Hospital in Vienna. The Birmingham researchers later demonstrated that early RA is characterized by a distinct and transient synovial fluid cytokine profile.2 Dr. Raza notes that these observations need to be reproduced in additional cohorts before being incorporated into predictive algorithms.
While the Birmingham EAC flourished, additional clinics began to emerge in other countries. In 1993, the department of rheumatology of the Leiden University Medical Center in The Netherlands established the Leiden EAC, “because we wanted to study the natural course of arthritis and identify prognostic markers for disease by well-organized follow-up schemes of all patients,” says Tom Huizinga, MD, professor of rheumatology at Leiden University Medical Center and director of the Leiden EAC.
The Leiden EAC’s earliest challenge was to contact all general practitioners in the area for referrals of patients with symptom duration of less than two years. Now, with a centralized database of over 2,000 patients, Dr. Huizinga says his group has demonstrated that patient outcome can be improved by rapid treatment initiation. Additionally, “an enormous amount of data have been gathered to better understand the pathogenesis and thereby establish better treatment schedules.”
While some of the earliest EACs were confined to clinical research units, in the 1990s EACS began to emerge as part of general rheumatology services worldwide, according to research by Mark A. Quinn, MBChB, MRCP, and Dr. Emery.3
