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; Nikiphorou, E; Ferraccioli, G; Schett, G; Hyrich, K; Müller-Ladner, U; Buch, MH; McInnes, IB; van der Heijde, D; van Laar, JM

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 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.

Citation

Nagy, G., Roodenrijs, N., Welsing, P., Kedves, M., Hamar, A., van der Goes, M., …van Laar, J. (2021). EULAR definition of difficult-to-treat rheumatoid arthritis. Annals of the Rheumatic Diseases, 80(1), 31-35. https://doi.org/10.1136/annrheumdis-2020-217344

• Journal Article Type: Article
• Acceptance Date: Aug 6, 2020
• Online Publication Date: Oct 1, 2020
• Publication Date: Jan 1, 2021
• Deposit Date: Aug 14, 2020
• Publicly Available Date: Oct 2, 2020
• Journal: Annals of the Rheumatic Diseases (ARD)
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Volume: 80
• Issue: 1
• Pages: 31-35
• DOI: https://doi.org/10.1136/annrheumdis-2020-217344
• Publisher URL: http://dx.doi.org/10.1136/annrheumdis-2020-217344
• Related Public URLs: http://ard.bmj.com/
• Additional Information: Projects : D2T RA EULAR Task Force