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.
