PT  - JOURNAL ARTICLE
AU  - György Nagy
AU  - Nadia M T Roodenrijs
AU  - Paco M J Welsing
AU  - Melinda Kedves
AU  - Attila Hamar
AU  - Marlies C van der Goes
AU  - Alison Kent
AU  - Margot Bakkers
AU  - Polina Pchelnikova
AU  - Etienne Blaas
AU  - Ladislav Senolt
AU  - Zoltan Szekanecz
AU  - Ernest H Choy
AU  - Maxime Dougados
AU  - Johannes WG Jacobs
AU  - Rinie Geenen
AU  - Johannes WJ Bijlsma
AU  - Angela Zink
AU  - Daniel Aletaha
AU  - Leonard Schoneveld
AU  - Piet van Riel
AU  - Sophie Dumas
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
TI  - EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis
AID  - 10.1136/annrheumdis-2021-220973
DP  - 2022 Jan 01
TA  - Annals of the Rheumatic Diseases
PG  - 20--33
VI  - 81
IP  - 1
4099  - http://ard.bmj.com/content/81/1/20.short
4100  - http://ard.bmj.com/content/81/1/20.full
SO  - Ann Rheum Dis2022 Jan 01; 81
AB  - Objective To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA).Methods An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A–D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0–10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members.Results Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4–9.6).Conclusions These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.