Difficult-to-treat rheumatoid arthritis: what have we learned and what do we still need to learn?

Abstract

Difficult-to-treat RA (D2T RA) is an area of high unmet need. The prevalence reported in the first D2T RA cohort studies ranged from 5.5% to 27.5%. Key to the definition is a conviction by the patient and/or rheumatologist that disease management has become problematic and failure of at least two biological or targeted synthetic DMARDs. D2T RA is a multifactorial disease state which was reflected in data from D2T RA cohort studies: these pointed towards high prevalence of comorbidities and/or lower socioeconomic status in D2T RA subgroups, while others had persistent symptoms without these factors being present. A holistic approach is necessary to identify the root problems underlying D2T RA in individual patients. In this review, biological and non-biological drivers that should be considered to be optimized will be discussed in view of what we have learned from patient data emerging from the first D2T RA cohort studies.

Keywords: D2T RA; difficult-to-treat RA; patient management; rheumatoid arthritis.

Figure 1.

Factors contributing to difficult-to-treat RA

Figure 2.

Treatment algorithm for difficult-to-treat RA as based on the EULAR point to consider for the treatment of RA. ^aAdapted figure from. Nagy et al. [32]