Research agenda
| 1 | How can we optimally confirm a diagnosis of RA in patients with D2T RA? |
| 2 | Which reference standard should be used to assess the presence or absence of inflammation in patients with D2T RA, in whom there is a doubt after assessment by traditional measures? |
| 3 | What is the role of synovial biopsies in the assessment of the presence or absence of inflammation in D2T RA? |
| 4 | Could synovial tissue analyses be used to stratify b/tsDMARD treatment in D2T RA? |
| 5 | Could treatment history be used to stratify b/tsDMARD treatment in D2T RA? |
| 6 | Are any of the b/tsDMARDs superior to treat inflammatory disease activity in D2T RA? |
| 7 | Which DMARD is preferred in patients with D2T RA with specific adverse events, comorbidities (including extra-articular manifestations), other coexisting conditions and other contraindications that limit DMARD options?* |
| 8 | Could the development of the D2T RA state be prevented by adequate management of the potentially contributing factors in an earlier phase of RA? |
| 9 | Could the D2T RA state be ameliorated if potentially contributing factors are adequately addressed? |
| 10 | Does ‘true’ refractory RA (patients in whom (b/ts)DMARDs are truly ineffective) really exist? |
| 11 | Which immunological mechanisms and/or pathways underlie inefficacy to multiple b/tsDMARDs in D2T RA? |
| 12 | How does smoking impact D2T RA? |
| 13 | How does obesity impact D2T RA? And which treatment is preferred in patients with D2T RA with obesity? |
| 14 | What is the role of therapeutic drug monitoring to in the management of DT RA? |
*For example, infections (HIV and TB); malignancies; lung disease (fibrosis, asthma and COPD); CVD (hypertension and cardiomyopathy); hyperlipidaemia; chronic kidney dysfunction; chronic liver dysfunction; liver enzyme elevation; osteoporosis; diabetes mellitus; thrombosis; depression and anxiety.
b/tsDMARDs, biological or targeted synthetic disease-modifying antirheumatic drugs; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; D2T, difficult-to-treat; RA, rheumatoid arthritis; TB, tuberculosis.