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EULAR definition of difficult-to-treat rheumatoid arthritis

Nagy, György, Roodenrijs, Nadia MT, Welsing, Paco MJ, Kedves, Melinda, Hamar, Attila, van der Goes, Marlies C, Kent, Alison, Bakkers, Margot, Blaas, Etienne, Senolt, Ladislav, Szekanecz, Zoltan, Choy, Ernest, Dougados, Maxime, Jacobs, Johannes W.G., Geenen, Rinie, Bijlsma, Hans W.J., Zink, Angela, Aletaha, Daniel, Schoneveld, Leonard, van Riel, Piet, Gutermann, Loriane, Prior, Yeliz, Nikiphorou, Elena, Ferraccioli, Gianfranco, Schett, Georg, Hyrich, Kimme L., Mueller-Ladner, Ulf, Buch, Maya H., McInnes, Iain B., van der Heijde, Désirée and van Laar, Jacob M. 2021. EULAR definition of difficult-to-treat rheumatoid arthritis. Annals of the Rheumatic Diseases 80 (1) , pp. 31-35. 10.1136/annrheumdis-2020-217344

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license
Publisher: BMJ Publishing Group
ISSN: 0003-4967
Date of First Compliant Deposit: 3 March 2021
Date of Acceptance: 6 August 2020
Last Modified: 04 Mar 2021 10:15

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