Characteristics of Difficult-to-treat Rheumatoid Arthritis: Based on an International Survey

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Characteristics of Difficult-to-treat Rheumatoid Arthritis: Based on an International Survey
Key Take-Away: 

This study, based on an international survey emphasis on the difficulty in establishing an unambiguous concept of difficult-to-treat rheumatoid arthritis (RA), which is seen as a heterogeneous condition and not fully covered by current EULAR recommendations. A more detailed survey is still needed to study the management of difficult-to-treat RA further and the recently established EULAR Task Force will explore the management of difficult-to-treat RA.


Patients with difficult-to-treat RA remain symptomatic despite treatment as per the current European League Against Rheumatism (EULAR) management recommendations. These aim at early phases of the disease and pharmacological management. The researchers tried to identify the characteristics of difficult-to-treat RA and issues in its management that are not covered by the current management recommendations.



An international survey was performed among the rheumatologists with multiple-choice questions concerning disease characteristics of difficult-to-treat RA. Additional items to be addressed and items missing in the current management recommendations were recognised using open questions.



Overall, 410 respondents completed the survey out of which 50% selected disease activity score examining 28 joints >3.2 OR presence of signs indicative of active disease as features of difficult-to-treat RA; 42% selected fatigue; 48% selected failure to ≥2 conventional synthetic DMARDs AND ≥2 biological/targeted synthetic DMARDs; 89% selected inability to attenuate glucocorticoids below 5 mg or 10 mg prednisone equivalent daily. Interfering comorbidities, extra-articular manifestations and polypharmacy were recognised as essential issues absent in current management recommendations.



There is wide variation in the theory of difficult-to-treat RA. Current EULAR recommendations do not address several important issues regarding these patients.


Annals of the Rheumatic Disease


Original title of article:

Characteristics of difficult-to-treat rheumatoid arthritis: results of an international survey


Nadia M T Roodenrijs et al.

Exploratory, Disease-modifying antirheumatic drugs (DMARDs), Glucocorticoids, Prednisone, Rheumatoid arthritis (RA), International survey
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