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

There is a clear need to assess patients presenting with a new onset of inflammatory peripheral arthritis and/or back pain early. Indeed, the clinical presentation of rheumatoid arthritis (RA) is not always characteristic but its early diagnosis is crucial to prevent irreversible structural damage. Likewise low back pain is common in the general population but may be related to ankylosing 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 implications. 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 better focused follow-up of these patients in appropriate secondary clinics. Since the sustained remission of inflammatory 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 early inception cohorts that allow for the characterization of the different disease phenotypes.