RT Journal Article
SR Electronic
T1 Characteristics of difficult-to-treat rheumatoid arthritis: results of an international survey
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1705
OP 1709
DO 10.1136/annrheumdis-2018-213687
VO 77
IS 12
A1 Nadia M T Roodenrijs
A1 Maria J H de Hair
A1 Marlies C van der Goes
A1 Johannes W G Jacobs
A1 Paco M J Welsing
A1 Désirée van der Heijde
A1 Daniel Aletaha
A1 Maxime Dougados
A1 Kimme L Hyrich
A1 Iain B McInnes
A1 Ulf Mueller-Ladner
A1 Ladislav Senolt
A1 Zoltan Szekanecz
A1 Jacob M van Laar
A1 György Nagy
A1 On behalf of the whole EULAR Task Force on development of EULAR recommendations for the comprehensive management of difficult-to-treat rheumatoid arthritis
YR 2018
UL http://ard.bmj.com/content/77/12/1705.abstract
AB Objectives Patients with difficult-to-treat rheumatoid arthritis (RA) remain symptomatic despite treatment according to current European League Against Rheumatism (EULAR) management recommendations. These focus on early phases of the disease and pharmacological management. We aimed to identify characteristics of difficult-to-treat RA and issues to be addressed in its workup and management that are not covered by current management recommendations.Methods An international survey was conducted among rheumatologists with multiple-choice questions on disease characteristics of difficult-to-treat RA. Using open questions, additional items to be addressed and items missing in current management recommendations were identified.Results 410 respondents completed the survey: 50% selected disease activity score assessing 28 joints >3.2 OR presence of signs suggestive of active disease as characteristics of difficult-to-treat RA; 42% selected fatigue; 48% selected failure to ≥2 conventional synthetic disease-modifying antirheumatic drugs (DMARDs) AND ≥2 biological/targeted synthetic DMARDs; 89% selected inability to taper glucocorticoids below 5 mg or 10 mg prednisone equivalent daily. Interfering comorbidities, extra-articular manifestations and polypharmacy were identified as important issues missing in current management recommendations.Conclusions There is wide variation in concepts of difficult-to-treat RA. Several important issues regarding these patients are not addressed by current EULAR recommendations.