EULAR definition of difficult-to-treat rheumatoid arthritis

Nagy, G, Roodenrijs, NMT, Welsing, PMJ, Kedves, M, Hamar, A, van der Goes, MC, Kent, A, Bakkers, M, Blaas, E, Senolt, L, Szekanecz, Z, Choy, E, Dougados, M, W.G. Jacobs, J, Geenen, R, Bijlsma, JWJ, Angela, Z, Aleteha, D, Schoneveld, L, van Riel, P, Gutermann, L, Prior, Y ORCID:, Nikiphorou, E, Ferraccioli, G, Schett, G, Hyrich, K, Müller-Ladner, U, Buch, MH, McInnes, IB, van der Heijde, D and van Laar, JM 2021, 'EULAR definition of difficult-to-treat rheumatoid arthritis' , Annals of the Rheumatic Diseases (ARD), 80 (1) , pp. 31-35.

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Background: Despite treatment according to the current management recommendations, a significant proportion of patients with rheumatoid arthritis (RA) remain symptomatic. These patients can be considered to have ‘difficult-to-treat RA’. However, uniform terminology and an appropriate definition are lacking. Objective: The Task Force in charge of the „Development of EULAR recommendations for the comprehensive management of difficult-to-treat rheumatoid arthritis” aims to create recommendations for this underserved patient group. Herein, we present the definition of difficult-to treat RA, as the first step. Methods: The Steering Committee drafted a definition with suggested terminology based on an international survey among rheumatologists. This was discussed and amended by the Task Force, including rheumatologists, nurses, health professionals and patients, at a face-to-face meeting until sufficient agreement was reached (assessed through voting). Results: The following three criteria were agreed by all Task Force members as mandatory elements of the definition of difficult-to-treat RA: 1) Treatment according to EULAR rec-ommendation and failure of ≥2 b/tsDMARDs (with different mechanisms of action) after failing csDMARD therapy (unless contraindicated); 2) presence of at least one of the follow-ing: at least moderate disease activity; signs and/or symptoms suggestive of active disease; inability to taper glucocorticoid treatment; rapid radiographic progression; RA symptoms that are causing a reduction in quality of life; 3) the management of signs and/or symptoms is perceived as problematic by the rheumatologist and/or the patient. Conclusions: The proposed EULAR definition for difficult-to-treat RA can be used in clinical practice, clinical trials and can form a basis for future research.

Item Type: Article
Schools: Schools > School of Health and Society > Centre for Health Sciences Research
Journal or Publication Title: Annals of the Rheumatic Diseases (ARD)
Publisher: BMJ Publishing Group
ISSN: 0003-4967
Related URLs:
Funders: European League Against Rheumatism (EULAR)
Depositing User: Dr Yeliz Prior
Date Deposited: 14 Aug 2020 14:48
Last Modified: 28 Aug 2021 11:50

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