title: Does early arthritis clinic organisation improve outcomes? What evidence is there? A systematic review.
abstract: OBJECTIVE
  To perform a systematic review aimed to identify studies addressing the effect of the establishment of a structured organisation programme, named early arthritis clinic (EAC), finalized to manage patients with early arthritis (EA) or suspected early rheumatoid arthritis (ERA).
  
  
  METHODS
  A literature search was performed until May 2012 using electronic databases. Additional information was obtained through a hand and grey literature search. Primary and secondary outcomes and eligibility criteria have been defined.
  
  
  RESULTS
  The search provided a total of 3367 citations and, after the selection process, 11 non randomised controlled trials were selected, including a total of 8240 participants. The efficacy of EAC did clearly emerge with regard to reduction of the referral lag time and of the time to treatment (secondary outcomes). Only two studies met the primary outcomes: one study demonstrated that the EAC contributed to reducing disease activity and radiographic progression but not functional disability, while another reported a reduction of pain after a 6-12-month period of follow-up.
  
  
  CONCLUSIONS
  Whether the establishment of EAC would improve the prognosis of EA in terms of primary outcomes such as clinical, functional and radiologic progression compared to patients managed outside from EAC does appear a still poorly addressed issue in the literature, which should be recognised as an urgent unmet need by the rheumatology community to gain more evidence-based information on this topic.
authors: Department of Medical Sciences, University of Ferrara, Italy. gvl@unife.it
authors: Marcello
authors: M
authors: Govoni
authors: Carlo Alberto
authors: CA
authors: Sciré
authors: Maria
authors: M
authors: Manara
authors: Nazzarena
authors: N
authors: Malavolta
authors: Luana
authors: L
authors: Mancarella
authors: Gilda
authors: G
authors: Sandri
authors: Fabio
authors: F
authors: Mascella
authors: Pier Luigi
authors: PL
authors: Macchioni
authors: Giovanni
authors: G
authors: Delsante
authors: Melissa
authors: M
authors: Padovan
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001168:Arthritis / Q000628:therapy*; D001172:Arthritis, Rheumatoid / Q000628:therapy; D018450:Disease Progression; D061345:Early Medical Intervention / Q000458:organization & administration*; D006801:Humans; D012017:Referral and Consultation; D016896:Treatment Outcome