EULAR definition of difficult-to-treat rheumatoid arthritis
Nagy, G.; Roodenrijs, N.M.; Welsing, P.M.; Kedves, M.; Hamar, A.; van der Goes, M.C.; Kent, A.; Bakkers, M.; Blaas, E.; Senolt, L.; Szekanecz, Z.; Choy, E.; Dougados, M.; Jacobs, J.W.; Geenen, R.; Bijlsma, H.W.; Zink, A.; Aletaha, D.; Schoneveld, L.; van Riel, P.; Gutermann, L.; Prior, Y.; Nikiphorou, E.; Ferraccioli, G.; Schett, G.; Hyrich, K.L.; Mueller-Ladner, U.; Buch, M.H.; McInnes, I.B.; van der Heijde, D.; van Laar, J.M.
(2021) Annals of the Rheumatic Diseases, volume 80, issue 1, pp. 31 - 35
(Article)
Abstract
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
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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 European League Against Rheumatism (EULAR) recommendation and failure of ≥2 biological disease-modifying antirheumatic drugs (DMARDs)/targeted synthetic DMARDs (with different mechanisms of action) after failing conventional synthetic DMARD therapy (unless contraindicated); (2) presence of at least one of the following: 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; and (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.
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Keywords: arthritis, immune system diseases, rheumatoid, synovitis, Rheumatology, Immunology and Allergy, Immunology, Biochemistry, Genetics and Molecular Biology(all)
ISSN: 0003-4967
Publisher: BMJ Publishing Group
Note: Funding Information: This study was funded by European League Against Rheumatism. Publisher Copyright: © Author(s) (or their.
(Peer reviewed)