TY - JOUR T1 - EULAR definition of difficult-to-treat rheumatoid arthritis JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 31 LP - 35 DO - 10.1136/annrheumdis-2020-217344 VL - 80 IS - 1 AU - György Nagy AU - Nadia MT Roodenrijs AU - Paco MJ Welsing AU - Melinda Kedves AU - Attila Hamar AU - Marlies C van der Goes AU - Alison Kent AU - Margot Bakkers AU - Etienne Blaas AU - Ladislav Senolt AU - Zoltan Szekanecz AU - Ernest Choy AU - Maxime Dougados AU - Johannes WG Jacobs AU - Rinie Geenen AU - Hans WJ Bijlsma AU - Angela Zink AU - Daniel Aletaha AU - Leonard Schoneveld AU - Piet van Riel AU - Loriane Gutermann AU - Yeliz Prior AU - Elena Nikiphorou AU - Gianfranco Ferraccioli AU - Georg Schett AU - Kimme L Hyrich AU - Ulf Mueller-Ladner AU - Maya H Buch AU - Iain B McInnes AU - Désirée van der Heijde AU - Jacob M van Laar Y1 - 2021/01/01 UR - http://ard.bmj.com/content/80/1/31.abstract N2 - 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. ER -