{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T22:52:14Z","timestamp":1788648734559,"version":"build-2803163510"},"reference-count":36,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2020,12,13]],"date-time":"2020-12-13T00:00:00Z","timestamp":1607817600000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","award":["Starting grant, agreement no. 714312"],"award-info":[{"award-number":["Starting grant, agreement no. 714312"]}],"id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006315","name":"ReumaNederland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006315","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,9,8]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Healthcare professionals other than rheumatologists experience difficulties in detecting early inflammatory arthritis (IA) by joint examination. Self-reported symptoms are increasingly considered as helpful and could be incorporated in online tools to assist healthcare professionals, but first their discriminative ability must be assessed. As part of this effort, we evaluated whether inquiring about functional impairments could aid early IA identification.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cross-sectional derivation and validation study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Data from two Early Arthritis Recognition Clinics (EARC) in the Netherlands were studied, which are easy access outpatient rheumatology clinics intermediary between primary and secondary care for patients in whom general practitioners suspect but are unsure about IA presence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Between 2010 and 2014, 997 patients consecutively visited the Leiden-EARC (derivation cohort). Patients consecutively visiting the Groningen EARC (2010\u20132014, n=506) and Leiden-EARC (2015\u20132018, n=557) served as validation cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>Physical functioning was assessed with the Health Assessment Questionnaire Disability-Index (HAQ); IA presence by physical joint examination by rheumatologists. HAQ questions were studied individually regarding discriminative ability for IA presence. For the best discriminating question, ORs and positive predictive values (PPVs) for IA presence were determined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>IA was ascertained in 43% (derivation cohort), 53% and 35% (validation cohorts). In the derivation cohort, IA presence associated with higher mean HAQ scores (0.84 vs 0.73, p=0.003). One question on difficulties with dressing equalled discriminative ability of the total HAQ score. \u2018Difficulties with dressing\u2019 yielded ORs for IA presence of 1.8 (95% CI 1.4 to 2.4) in the derivation cohort; 2.0 (1.4 to 2.9) and 2.1 (1.5 to 3.1) in the validation cohorts. After adjustments for clinical characteristics these were 1.7 (1.3 to 2.3), 1.6 (1.1 to 2.5) and 1.9 (1.2 to 2.9). PPVs (probabilities of IA for positive answers) ranged 42%\u201360%\u2009and negative predictive values (probabilities of no IA for negative answers) ranged 57%\u201374%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patient-reported difficulties with dressing in patients with suspected IA associated with actual IA presence. Although further validation is required, for example, in primary care, this simple question could be of help in future early IA detection tools for healthcare professionals with limited experience in joint examination.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-040148","type":"journal-article","created":{"date-parts":[[2020,12,13]],"date-time":"2020-12-13T23:35:29Z","timestamp":1607902529000},"page":"e040148","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["The value of inquiring about functional impairments for early identification of inflammatory arthritis: a large cross-sectional derivation and validation study from the Netherlands"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5161-6791","authenticated-orcid":false,"given":"Bastiaan T","family":"van Dijk","sequence":"first","affiliation":[{"name":"Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna W","family":"van Steenbergen","sequence":"additional","affiliation":[{"name":"Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellis","family":"Niemantsverdriet","sequence":"additional","affiliation":[{"name":"Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8572-1437","authenticated-orcid":false,"given":"Annette HM","family":"van der Helm-van Mil","sequence":"additional","affiliation":[{"name":"Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,12,13]]},"reference":[{"key":"2025101812290906000_10.12.e040148.1","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2015-000057"},{"key":"2025101812290906000_10.12.e040148.2","doi-asserted-by":"publisher","DOI":"10.1002\/art.27692"},{"key":"2025101812290906000_10.12.e040148.3","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210775"},{"key":"2025101812290906000_10.12.e040148.4","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1002\/acr.23474","article-title":"Treating early undifferentiated arthritis: a systematic review and meta-analysis of direct and indirect trial evidence","volume":"70","author":"Lopez-Olivo","year":"2018","journal-title":"Arthritis Care Res"},{"key":"2025101812290906000_10.12.e040148.5","first-page":"21","article-title":"Early treatment of psoriatic arthritis improves prognosis","volume":"258","author":"McLaughlin","year":"2014","journal-title":"Practitioner"},{"key":"2025101812290906000_10.12.e040148.6","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210602"},{"key":"2025101812290906000_10.12.e040148.7","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3109\/13814788.2015.1084279","article-title":"A general practice perspective on early rheumatoid arthritis management: a qualitative study from Flanders","volume":"21","author":"Meyfroidt","year":"2015","journal-title":"Eur J Gen Pract"},{"key":"2025101812290906000_10.12.e040148.8","unstructured":"NIVEL . Zorgregistraties eerste lijn: Incidenties en prevalenties [online], 2017. Available: https:\/\/www.nivel.nl\/nl\/zorgregistraties-eerste-lijn\/incidenties-en-prevalenties [Accessed 5 Feb 2019]."},{"key":"2025101812290906000_10.12.e040148.9","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-202634"},{"key":"2025101812290906000_10.12.e040148.10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-11-144"},{"key":"2025101812290906000_10.12.e040148.11","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.151902"},{"key":"2025101812290906000_10.12.e040148.12","doi-asserted-by":"crossref","DOI":"10.2196\/mhealth.4924","article-title":"Health APP use among US mobile phone owners: a national survey","volume":"3","author":"Krebs","year":"2015","journal-title":"JMIR Mhealth Uhealth"},{"key":"2025101812290906000_10.12.e040148.13","doi-asserted-by":"crossref","DOI":"10.2196\/mhealth.4169","article-title":"Expert involvement and adherence to medical evidence in medical mobile phone Apps: a systematic review","volume":"3","author":"Subhi","year":"2015","journal-title":"JMIR Mhealth Uhealth"},{"key":"2025101812290906000_10.12.e040148.14","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780230202"},{"key":"2025101812290906000_10.12.e040148.15","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-1-20"},{"key":"2025101812290906000_10.12.e040148.16","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-202289"},{"key":"2025101812290906000_10.12.e040148.17","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev432"},{"key":"2025101812290906000_10.12.e040148.18","unstructured":"Nederlands Huisartsen Genootschap . NHG-standaard artritis (eerste herziening) [online], 2017. Available: https:\/\/www.nhg.org\/standaarden\/volledig\/nhg-standaard-artritis [Accessed 5 Feb 2019]."},{"key":"2025101812290906000_10.12.e040148.19","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.102244"},{"key":"2025101812290906000_10.12.e040148.20","doi-asserted-by":"publisher","DOI":"10.1002\/art.20048"},{"key":"2025101812290906000_10.12.e040148.21","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023552"},{"key":"2025101812290906000_10.12.e040148.22","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4067"},{"key":"2025101812290906000_10.12.e040148.23","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-9-57"},{"key":"2025101812290906000_10.12.e040148.24","first-page":"167","article-title":"The Stanford health assessment questionnaire: a review of its history, issues, progress, and documentation","volume":"30","author":"Bruce","year":"2003","journal-title":"J Rheumatol"},{"key":"2025101812290906000_10.12.e040148.25","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-11-50"},{"key":"2025101812290906000_10.12.e040148.26","article-title":"The self-administered rheumatoid arthritis (rA) screening questionnaire (RASQ) is a simple and effective tool to detect RA patients","volume":"69","author":"Khraishi","year":"2010","journal-title":"Ann Rheum Dis"},{"key":"2025101812290906000_10.12.e040148.27","unstructured":"Maksymowych WP , Russell A , Homik J , et al . E-triage rheumatoid arthritis study in early arthritis (ERASE) [online], 2007. Available: http:\/\/www.arthritisdoctor.ca\/erase-intro.php [Accessed 28 Mar 2019]."},{"key":"2025101812290906000_10.12.e040148.28","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s10916-010-9606-9","article-title":"Diagnosis of arthritis through fuzzy inference system","volume":"36","author":"Singh","year":"2012","journal-title":"J Med Syst"},{"key":"2025101812290906000_10.12.e040148.29","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket190"},{"key":"2025101812290906000_10.12.e040148.30","doi-asserted-by":"crossref","first-page":"81","DOI":"10.2147\/OARRR.S134780","article-title":"Determining early referral criteria for patients with suspected inflammatory arthritis presenting to primary care physicians: a cross-sectional study","volume":"9","author":"Almoallim","year":"2017","journal-title":"Open Access Rheumatol"},{"key":"2025101812290906000_10.12.e040148.31","unstructured":"Croydon Health Services NHS Foundation Trust . Early arthritis services [online]. Available: https:\/\/www.croydonhealthservices.nhs.uk\/a-to-z-of-services\/service\/early-arthritis-service-151\/ [Accessed 19 Mar 2019]."},{"key":"2025101812290906000_10.12.e040148.32","doi-asserted-by":"publisher","DOI":"10.1136\/ard.61.4.290"},{"key":"2025101812290906000_10.12.e040148.33","unstructured":"Hampshire Hospitals NHS Foundation Trust . Early arthritis clinic referral form [online]. Available: https:\/\/www.hampshirehospitals.nhs.uk\/media\/616367\/updated_eac_form.pdf [Accessed 19 Mar 2019]."},{"key":"2025101812290906000_10.12.e040148.34","doi-asserted-by":"publisher","DOI":"10.1007\/s00393-005-0020-5"},{"key":"2025101812290906000_10.12.e040148.35","unstructured":"Musgrove Park Hospital . Early arthritis referral form [online]. Available: https:\/\/www.tsft.nhs.uk\/media\/353049\/early-arthritis-final.pdf [Accessed 19 Mar 2019]."},{"key":"2025101812290906000_10.12.e040148.36","unstructured":"The National Institute for Health and Care Excellence (NICE) . Rheumatoid arthritis in adults: management [online], 2018. Available: https:\/\/www.nice.org.uk\/guidance\/ng100 [Accessed 19 Mar 2019]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-040148","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T19:29:18Z","timestamp":1760815758000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-040148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":36,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,13]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/bmjopen-2020-040148"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-040148","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}