EULAR definition of difficult-to-treat rheumatoid arthritis
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
33004335
PubMed Central
PMC7788062
DOI
10.1136/annrheumdis-2020-217344
PII: S0003-4967(24)01097-5
Knihovny.cz E-resources
- Keywords
- arthritis, immune system diseases, rheumatoid, synovitis,
- MeSH
- Antirheumatic Agents therapeutic use MeSH
- Biological Products therapeutic use MeSH
- Glucocorticoids therapeutic use MeSH
- Drug Therapy, Combination MeSH
- Drug Resistance MeSH
- Humans MeSH
- Treatment Failure MeSH
- Advisory Committees MeSH
- Disease Progression MeSH
- Arthritis, Rheumatoid diagnostic imaging drug therapy physiopathology MeSH
- Rheumatology MeSH
- Practice Guidelines as Topic MeSH
- Terminology as Topic MeSH
- Stakeholder Participation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
- Names of Substances
- Antirheumatic Agents MeSH
- Biological Products MeSH
- Glucocorticoids MeSH
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.
Centre for Rheumatic Diseases King's College London London UK
Department of Genetics Cell and Immunobiology Semmelweis University Budapest Hungary
Department of Psychology Utrecht University Utrecht the Netherlands
Department of Rheumatic Diseases Radboud University Nijmegen Medical Centre Nijmegen the Netherlands
Department of Rheumatology Bács Kiskun County Hospital Kecskemét Hungary
Department of Rheumatology Bravis Hospital Roosendaal the Netherlands
Department of Rheumatology Faculty of Medicine University of Debrecen Debrecen Hungary
Department of Rheumatology Leiden University Medical Center Leiden the Netherlands
Department of Rheumatology Meander Medical Center Amersfoort the Netherlands
EULAR Standing Committee of People with Arthritis Rheumatism in Europe Zurich Switzerland
Institute of Infection Immunity and Inflammation University of Glasgow Glasgow UK
Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Leeds UK
Salisbury Foundation Trust NHS Hospital Wiltshire UK
School of Health and Society Centre for Health Sciences Research University of Salford Salford UK
School of Medicine Catholic University of the Sacred Heart Rome Italy
See more in PubMed
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EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis
