There is no firm consensus on what set of factors comprise difficult-to-treat rheumatoid arthritis (RA), according to a study recently published in Annals of the Rheumatic Diseases. An international survey revealed a variation of characteristics in the definition of the disease.

The survey used in this study included multiple-choice questions concerning characteristics of difficult-to-treat RA, while open questions allowed participants to list items that might have been missing from current procedures. This also allowed the study researchers to identify other items that need addressing. To gather information on respondents, the survey also included 2 questions on place of work and number of patients with RA who were treated.

This survey was completed by 410 rheumatologists in 33 countries, 50% of whom selected 28-jont Disease Activity Score using erythrocyte sedimentation rate (DAS28-ESR) >3.2 or presence of signs suggestive of active inflammatory disease activity with a DAS28-ESR ≤3.2 as a characteristic of difficult-to-treat RA. In terms of how many suboptimally effective antirheumatic drugs should be administered, 48% selected ≥2 conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and ≥2 biologic DMARDs or targeted synthetic DMARDs with different modes of action. Fatigue was listed by 42% of participants. The majority of respondents (89%) chose the inability to attenuate glucocorticoids less than 5 mg or 10 mg prednisone or daily equivalent. Certain factors were demonstrated to be lacking from current recommended management, including extra-articular manifestations, comorbidities that interfered with the disease, and polypharmacy.

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The study researchers concluded that “the results of this survey underscore the difficulty in establishing an unambiguous concept of difficult-to-treat RA, which is seen as a heterogeneous condition not fully covered by current EULAR recommendations. The recently established EULAR Task Force will explore the management of difficult-to-treat RA further.”

Several authors report receiving consulting fees from pharmaceutical companies, including Novartis, Gilead, and others. For a full list of author disclosures, see original article.

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Reference

Roodenrijs NMT, de Hair MJH, van der Goes MC, et al. Characteristics of difficult-to-treat rheumatoid arthritis: results of an international survey [published online September 7, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-213687.