TY - JOUR
T1 - Difficult-to-treat rheumatoid arthritis
T2 - an area of unmet clinical need
AU - de Hair, Maria J.H.
AU - Jacobs, Johannes W.G.
AU - Schoneveld, Jan L.M.
AU - van Laar, Jacob M.
N1 - Funding Information:
Disclosure statement: J.M.v.L. has received consultancy fees from Arthrogen, BMS, Eli Lilly, MSD, Pfizer and Roche, and research grants from Astra Zeneca, Genentech and MSD. All other authors have declared that they have no conflicts of interest.
Publisher Copyright:
© The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Increased effectiveness of pharmacological treatments in early RA has led many to believe that difficult-to-treat, established RA is a condition of the past. However, there are still plenty of RA patients who continue to have signs and symptoms suggestive of inflammatory disease activity, despite consecutive treatment with multiple conventional synthetic and biological DMARDs. We argue that difficult-to-treat RA constitutes an area of unmet clinical need and propose a definition of this concept. An overview of what is known about the multiple contributory factors varying for each individual patient, and an approach towards improved patient-tailored management are presented. This management approach involves thorough assessment to determine whether persistence of signs and symptoms is based on inflammatory disease activity, and the role of comorbidities. Furthermore, it addresses medication-related issues, such as non-adherence, patient beliefs and expectations, and setting of realistic treatment goals.
AB - Increased effectiveness of pharmacological treatments in early RA has led many to believe that difficult-to-treat, established RA is a condition of the past. However, there are still plenty of RA patients who continue to have signs and symptoms suggestive of inflammatory disease activity, despite consecutive treatment with multiple conventional synthetic and biological DMARDs. We argue that difficult-to-treat RA constitutes an area of unmet clinical need and propose a definition of this concept. An overview of what is known about the multiple contributory factors varying for each individual patient, and an approach towards improved patient-tailored management are presented. This management approach involves thorough assessment to determine whether persistence of signs and symptoms is based on inflammatory disease activity, and the role of comorbidities. Furthermore, it addresses medication-related issues, such as non-adherence, patient beliefs and expectations, and setting of realistic treatment goals.
KW - Biological therapies
KW - Inflammation
KW - Pain assessment and management
KW - Patient attitude to health
KW - Quality of healthcare
KW - Refractory
KW - Rheumatoid arthritis
KW - Synovitis
KW - Ultrasound
KW - refractory
KW - biological therapies
KW - pain assessment and management
KW - quality of healthcare
KW - rheumatoid arthritis
KW - ultrasound
KW - inflammation
KW - synovitis
KW - patient attitude to health
UR - http://www.scopus.com/inward/record.url?scp=85041281102&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/kex349
DO - 10.1093/rheumatology/kex349
M3 - Review article
C2 - 29029308
AN - SCOPUS:85041281102
SN - 1462-0324
VL - 57
SP - 1135
EP - 1144
JO - Rheumatology (United Kingdom)
JF - Rheumatology (United Kingdom)
IS - 7
ER -