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I would like to thank Roodenrijs et al1 for their thoughtful comments on my viewpoint ‘Defining refractory rheumatoid arthritis’2 and appreciate their acknowledgement of this important subgroup of patients with unmet clinical needs.
The authors highlight their description and recent review of ‘difficult to treat RA’3 that in contrast to my viewpoint includes refractory rheumatoid arthritis (RA) in the presence of persistent inflammation and in its absence. I acknowledge this approach is more inclusive in encompassing the breadth of reasons that contribute to challenging RA treatment decision making in real-world practice and …
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