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Actual clinical practices to manage difficult-to-treat RA varies from the current EULAR recommendations.

Actual clinical practices to manage difficult-to-treat RA varies from the current EULAR recommendations. Actual clinical practices to manage difficult-to-treat RA varies from the current EULAR recommendations.
Actual clinical practices to manage difficult-to-treat RA varies from the current EULAR recommendations. Actual clinical practices to manage difficult-to-treat RA varies from the current EULAR recommendations.

What's new?

There exists a wide inconsistency in concepts of difficult-to-treat RA. Active disease, failure to DMARD treatment and inability to taper GCs are considered as main characteristics. 

Rheumatoid arthritis (RA) remains symptomatic in some patients after several treatment cycles. European League Against Rheumatism (EULAR) management recommendations considered these patients as difficult-to treat. Nadia M T Roodenrijs and colleagues conducted an analysis to address characteristics of difficult-to-treat RA and associated options for its management which are not incorporated by recent management recommendations.

For this, an international survey was directed in the rheumatologists involving multiple-choice questions on difficult-to-treat RA features. Additional and missing items in the present management recommendations were identified through open questions.

Among 410 respondents, approximately 50% of patients selected measures of active disease and DAS-28 as characteristic of difficult-to-treat RA. However  89% selected inability to taper glucocorticoids below 5 mg or 10 mg prednisone equivalent daily, 42% selected fatigue and 48% selected failure to ≥2 conventional DMARDs and ≥2 biological/targeted synthetic DMARDs as the essential characteristics.

The critical problems that noticed to be missing in the current management recommendations were extra-articular indications, polypharmacy and interfering comorbidities. The vast differences were seen in the theories of difficult-to-treat RA. Current EULAR recommendations do not address several essential issues concerning these patients.

Source:

Annals of the Rheumatic Diseases

Article:

Characteristics of difficult-to-treat rheumatoid arthritis: results of an international survey

Authors:

Nadia M T Roodenrijs et al.

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