EULAR definition of difficult-To-Treat rheumatoid arthritis

Nagy G, Roodenrijs NM, Welsing PM, Kedves M, Hamar A, Van Der Goes MC, Kent A, Bakkers M, Blaas E, Senolt L, Szekanecz Z, Choy E, Dougados M, Jacobs JW, Geenen R, Bijlsma HW, Zink A, Aletaha D, Schoneveld L, Van Riel P, Gutermann L, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, Van Der Heijde D, Van Laar JM (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Book Volume: 80

Pages Range: 31-35

Journal Issue: 1

DOI: 10.1136/annrheumdis-2020-217344

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.

Authors with CRIS profile

Involved external institutions

Semmelweis University / Semmelweis Egyetem Hungary (HU) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Bács-Kiskun Megyei Kórház Hungary (HU) University of Debrecen / Debreceni Egyetem Hungary (HU) Salisbury District Hospital United Kingdom (GB) European League Against Rheumatism (EULAR) Switzerland (CH) Institute of Rheumatology / Revmatologický Ústav Czech Republic (CZ) Cardiff University United Kingdom (GB) Assistance Publique-Hôpitaux de Paris (AP-HP) France (FR) Universiteit Utrecht (UU) / Utrecht University Netherlands (NL) Charité - Universitätsmedizin Berlin Germany (DE) Medizinische Universität Wien Austria (AT) Bravis Hospital Netherlands (NL) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) Netherlands (NL) Université de Paris France (FR) University of Salford United Kingdom (GB) King’s College London United Kingdom (GB) Catholic University of the Sacred Heart / Università Cattolica del Sacro Cuore Italy (IT) Manchester University NHS Foundation Trust (MFT) United Kingdom (GB) Justus-Liebig-Universität Gießen Germany (DE) University of Glasgow United Kingdom (GB) Leiden University Medical Center Netherlands (NL)

How to cite

APA:

Nagy, G., Roodenrijs, N.M., Welsing, P.M., Kedves, M., Hamar, A., Van Der Goes, M.C.,... Van Laar, J.M. (2021). EULAR definition of difficult-To-Treat rheumatoid arthritis. Annals of the Rheumatic Diseases, 80(1), 31-35. https://doi.org/10.1136/annrheumdis-2020-217344

MLA:

Nagy, György, et al. "EULAR definition of difficult-To-Treat rheumatoid arthritis." Annals of the Rheumatic Diseases 80.1 (2021): 31-35.

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