TY - JOUR
T1 - EULAR definition of difficult-to-treat rheumatoid arthritis
AU - Nagy, György
AU - Roodenrijs, Nadia Mt
AU - Welsing, Paco Mj
AU - Kedves, Melinda
AU - Hamar, Attila
AU - van der Goes, Marlies C
AU - Kent, Alison
AU - Bakkers, Margot
AU - Blaas, Etienne
AU - Senolt, Ladislav
AU - Szekanecz, Zoltan
AU - Choy, Ernest
AU - Dougados, Maxime
AU - Jacobs, Johannes Wg
AU - Geenen, Rinie
AU - Bijlsma, Hans Wj
AU - Zink, Angela
AU - Aletaha, Daniel
AU - Schoneveld, Leonard
AU - van Riel, Piet
AU - Gutermann, Loriane
AU - Prior, Yeliz
AU - Nikiphorou, Elena
AU - Ferraccioli, Gianfranco
AU - Schett, Georg
AU - Hyrich, Kimme L
AU - Mueller-Ladner, Ulf
AU - Buch, Maya H
AU - McInnes, Iain B
AU - van der Heijde, Désirée
AU - van Laar, Jacob M
N1 - Funding Information:
This study was funded by European League Against Rheumatism.
Publisher Copyright:
© Author(s) (or their.
PY - 2021/1
Y1 - 2021/1
N2 - 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 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.
AB - 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 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.
KW - arthritis
KW - immune system diseases
KW - rheumatoid
KW - synovitis
UR - https://www.scopus.com/pages/publications/85098069546
U2 - 10.1136/annrheumdis-2020-217344
DO - 10.1136/annrheumdis-2020-217344
M3 - Article
C2 - 33004335
SN - 0003-4967
VL - 80
SP - 31
EP - 35
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 1
ER -