{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:37:17Z","timestamp":1790105837774,"version":"4.0.1"},"reference-count":49,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T00:00:00Z","timestamp":1591574400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2020,4,9]]},"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Little is known about relevant events in the at-risk phase of rheumatoid arthritis before the development of clinically apparent inflammatory arthritis (IA). The present study assessed musculoskeletal symptoms, infections and comorbidity in future IA patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a nested case\u2013control study using electronic health records of general practitioners, the frequency and timing of 192 symptoms or diseases were evaluated before a diagnosis of IA, using the International Classification of Primary Care coding system. Cases were 2314 adults with a new diagnosis IA between 2012 and 2016; controls were matched 1:2. The frequency of primary care visits was compared using logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s3\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The frequency of visits for musculoskeletal symptoms (mostly of shoulders, wrists, fingers and knees) and carpal tunnel syndrome was significantly higher in IA patients vs controls within the final 1.5\u00a0years before diagnosis, with ORs of 3.2 (95% CI 2.8 to 3.5), 2.8 (95% CI 2.5 to 3.1) and 2.5 (95% CI 2.2 to 2.8) at 6, 12 and 18\u00a0months before diagnosis, respectively. Also, infections (notably of the genital and urinary tracts), IA-comorbidities and chronic diseases were more prevalent in cases than controls, but more evenly spread out over the whole 6-year period before IA. A decision tree was created including all symptoms and diseases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s4\">\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>There was an increased frequency of primary care visits for musculoskeletal symptoms, infections and comorbidities prior to the diagnosis of IA. This diverging trend is present for 4\u20136\u00a0years, but becomes statistically significant 1.5\u00a0years before the diagnosis. Validation of these results is warranted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2019-001163","type":"journal-article","created":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T09:45:25Z","timestamp":1594201525000},"page":"e001163","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Increased primary care use for musculoskeletal symptoms, infections and comorbidities in the years before the diagnosis of inflammatory arthritis"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4200-2894","authenticated-orcid":false,"given":"Marian van","family":"Beers-Tas","sequence":"first","affiliation":[{"name":"Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus MJ","family":"Nielen","sequence":"additional","affiliation":[{"name":"Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos W R","family":"Twisk","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joke","family":"Korevaar","sequence":"additional","affiliation":[{"name":"Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"van Schaardenburg","sequence":"additional","affiliation":[{"name":"Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands"},{"name":"Rheumatology, Amsterdam Rheumatology & immunology Center, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,7,8]]},"reference":[{"key":"2025090313072791000_6.2.e001163.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.151902"},{"key":"2025090313072791000_6.2.e001163.2","doi-asserted-by":"crossref","DOI":"10.1186\/ar2362","article-title":"Antibodies to mutated citrullinated vimentin and disease activity score in early arthritis: a cohort study","volume":"10","author":"Ursum","year":"2008","journal-title":"Arthritis Res Ther"},{"key":"2025090313072791000_6.2.e001163.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.27692"},{"key":"2025090313072791000_6.2.e001163.4","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev432"},{"key":"2025090313072791000_6.2.e001163.5","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1002\/acr.22146","article-title":"Increased frequency and costs of ambulatory medical care utilization prior to the diagnosis of rheumatoid arthritis: a national population-based study","volume":"66","author":"Lai","year":"2014","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313072791000_6.2.e001163.6","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.144139"},{"key":"2025090313072791000_6.2.e001163.7","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmt037"},{"key":"2025090313072791000_6.2.e001163.8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2005.040659"},{"key":"2025090313072791000_6.2.e001163.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2014.07.001"},{"key":"2025090313072791000_6.2.e001163.10","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e3283477b7b"},{"key":"2025090313072791000_6.2.e001163.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2015.09.001"},{"key":"2025090313072791000_6.2.e001163.12","doi-asserted-by":"crossref","unstructured":"Mankia K , Nam J , Emery P . 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