EULAR definition of difficult-to-treat rheumatoid arthritis.
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.
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D026683:Advisory Committees D018501:Antirheumatic Agents D001172:Arthritis, Rheumatoid D001688:Biological Products D018450:Disease Progression D004351:Drug Resistance D004359:Drug Therapy, Combination D005060:Europe D005938:Glucocorticoids D006801:Humans D017410:Practice Guidelines as Topic D012219:Rheumatology D000073597:Stakeholder Participation D009626:Terminology as Topic D017211:Treatment Failure
rheumatoid arthritis immune system diseases synovitis