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Single-centre retrospective analysis of 290 consecutive patients. At each EAC appointment, a structured assessment comprising medical history, review of available laboratory results, focused physical examination, and arthrosonography was performed. Variables included demographics, serology (RF, anti-CCP), CRP, ESR, imaging, referral source, waiting time, and treatment decisions. Chi-squared, Mann\u2013Whitney U, Kruskal\u2013Wallis tests, and binary logistic regression were performed; p\u2009&lt;\u20090.05 was considered significant. The cohort comprised 212 women (73.1%) and 78 men (26.9%), mean age 49.4\u2009\u00b1\u200915.9\u00a0years. Median waiting time was 23\u00a0days (Q1\u2013Q3, 14\u201340). Although a complete baseline panel (RF, anti-CCP, CRP, ESR) was requested from referring physicians, it was available in only 110 patients (37.9%). Anti-CCP was missing in 34.5%, with missingness significantly associated with referral source (p\u2009=\u20090.013). Inflammatory arthritis was confirmed in 145 patients (50.0%) and DMARD initiation recommended in 130 (44.8%). In multivariable logistic regression (n\u2009=\u2009163 with full serology), anti-CCP positivity was independently associated with arthritis confirmation (OR 4.25; 95% CI 1.68\u201310.74) and DMARD initiation (OR 4.49; 95% CI 1.80\u201311.22). Orthopaedist referral was independently associated with higher arthritis confirmation (OR 2.97; 95% CI 1.20\u20137.36). RF was not significantly associated with either outcome. EACs demonstrate high diagnostic yield for inflammatory joint disease. Anti-CCP positivity showed the strongest independent association with both outcomes. Pre-referral laboratory submission was achieved in fewer than 40% of patients despite being a stated referral requirement, with missingness associated with referral source. Targeted educational interventions for referring physicians are warranted.<\/jats:p>","DOI":"10.1007\/s00296-026-06213-1","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T07:09:22Z","timestamp":1783148962000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre-referral laboratory completeness and diagnostic yield in an early arthritis clinic: a retrospective single-centre analysis"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6616-0377","authenticated-orcid":false,"given":"Luisa","family":"Schneider","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8385-6861","authenticated-orcid":false,"given":"J\u00f6rg Christoph","family":"Henes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7259-1207","authenticated-orcid":false,"given":"Sebastian Jonas","family":"Saur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"issue":"10055","key":"6213_CR1","doi-asserted-by":"publisher","first-page":"2023","DOI":"10.1016\/S0140-6736(16)30173-8","volume":"388","author":"JS Smolen","year":"2016","unstructured":"Smolen JS, Aletaha D, McInnes IB (2016) Rheumatoid arthritis. Lancet 388(10055):2023\u20132038. https:\/\/doi.org\/10.1016\/S0140-6736(16)30173-8","journal-title":"Lancet"},{"issue":"5","key":"6213_CR2","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1136\/annrheumdis-2012-203130","volume":"73","author":"JAB van Nies","year":"2014","unstructured":"van Nies JAB, Krabben A, Schoones JW, Huizinga TWJ, Kloppenburg M, van der Helm-van Mil AHM (2014) What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review. Ann Rheum Dis 73(5):861\u2013870. https:\/\/doi.org\/10.1136\/annrheumdis-2012-203130","journal-title":"Ann Rheum Dis"},{"issue":"1","key":"6213_CR3","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2018-000870","volume":"5","author":"LE Burgers","year":"2019","unstructured":"Burgers LE, Raza K, van der Helm-van Mil AHM (2019) Window of opportunity in rheumatoid arthritis \u2013 definitions and supporting evidence: from old to new perspectives. 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All procedures comply with the 1964 Declaration of Helsinki and its later amendments. The requirement for individual written informed consent was waived by the Ethics Committee owing to the fully anonymised, retrospective nature of the data analysis.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No part of this work has been presented at a congress or published as a congress abstract.","order":3,"name":"Ethics","label":"Presentation at a congress","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"A large language model, Claude (Anthropic; models Claude Opus 4.8), was used between May and June 2026 to assist with manuscript drafting and language editing, statistical output formatting, and reference organisation. All AI-generated content was carefully reviewed, verified against source data, and revised by the authors. All statistical analyses, clinical interpretations, and scientific conclusions are the sole responsibility of the authors. No part of this manuscript was submitted for AI generation without subsequent author review and approval.","order":4,"name":"Ethics","label":"AI use statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that no part of this report has been copied from any other publication, is currently under consideration for publication elsewhere, or has been generated by artificial intelligence without full review, verification, and revision by the authors.","order":5,"name":"Ethics","label":"Disclaimer","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This manuscript was prepared in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement for cohort and cross-sectional studies. A completed STROBE checklist is submitted as a supplementary file [\n                      \n                      ].","order":6,"name":"Ethics","label":"STROBE statement","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"187"}}