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 ORCID: https://orcid.org/0000-0003-4459-8609, 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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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 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 |
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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: | 03 May 2023 20:58 |
URI: | https://orca.cardiff.ac.uk/id/eprint/139242 |
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