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There exists a wide
inconsistency in concepts of difficult-to-treat RA. Active disease, failure to
DMARD treatment and inability to taper GCs are considered as main
characteristics.
Rheumatoid arthritis (RA) remains symptomatic in some patients after several treatment cycles. European League Against Rheumatism (EULAR) management recommendations considered these patients as difficult-to treat. Nadia M T Roodenrijs and colleagues conducted an analysis to address characteristics of difficult-to-treat RA and associated options for its management which are not incorporated by recent management recommendations.
For this, an international survey was directed in the rheumatologists involving multiple-choice questions on difficult-to-treat RA features. Additional and missing items in the present management recommendations were identified through open questions.
Among 410
respondents, approximately 50% of patients selected measures of active disease
and DAS-28 as characteristic of difficult-to-treat RA. However 89% selected inability to taper
glucocorticoids below 5 mg or 10 mg prednisone equivalent daily, 42% selected
fatigue and 48% selected failure to ≥2 conventional DMARDs and ≥2
biological/targeted synthetic DMARDs as the essential characteristics.
The critical
problems that noticed to be missing in the current management recommendations
were extra-articular indications, polypharmacy and interfering comorbidities.
The vast differences were seen in the theories of difficult-to-treat RA.
Current EULAR recommendations do not address several essential issues
concerning these patients.
Annals of the Rheumatic Diseases
Characteristics of difficult-to-treat rheumatoid arthritis: results of an international survey
Nadia M T Roodenrijs et al.
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