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The advent of biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) has improved the management of rheumatoid arthritis (RA) dramatically. However, there are patients who have not been controlled adequately, and EULAR has recently proposed a definition of difficult-to-treat RA (D2T RA).1 We have verified the definition in our institution, where approximately 60% of 1700 patients with RA have been treated with b/tsDMARDs based on the EULAR recommendation and treat-to-target strategy,2 3 resulting in roughly 85% achieving target (60% in remission and 25% in low disease activity),4 5 and revealed that 10% are classified as D2T RA at the last visit.5 In the process of this investigation, we further identified 77 patients (5%) who were on the borderline of non-D2T RA despite being in moderate or high disease activity due to non-fulfilment of the criterion of failure of two b/tsDMARDs with different mechanisms of action.5
We compared the characteristics of the 77 non-D2T RA patients in moderate or high disease activity with those of the non-D2T RA patients in remission or low disease activity (table 1). The patients in moderate or high disease …
Handling editor Josef S Smolen
Contributors ST, YK and TT designed the study and wrote the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests YK has received grants or speaking fees from AbbVie, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Hisamitsu, Jansen, Kissei, Pfizer, Sanofi, Takeda, Tanabe-Mitsubishi and UCB. TT has received research grants or speaking fees from Astellas Pharma, Bristol–Myers KK, Chugai Pharmaceutical Co, Daiichi Sankyo Co, Takeda Pharmaceutical Co, Teijin Pharma, AbbVie GK, Asahikasei Pharma Corp, Mitsubishi Tanabe Pharma, Astra Zeneca KK, Eli Lilly Japan KK, Novartis Pharma KK, Abbivie GK, Nipponkayaku Co, Janssen, Pharmaceutical KK, Taiho Pharmaceutical Co and Pfizer Japan.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.