Management

EULAR Publishes Definition for Difficult-to-Treat RA

The European League Against Rheumatism (EULAR) has proposed a definition for difficult-to-treat rheumatoid arthritis (RA).

According to the task force that developed the definition, uniform terminology and an appropriate definition for difficult-to-treat RA had been lacking. The task force sought to make the definition more concrete in preparation of the EULAR recommendations for the comprehensive management of difficult-to-treat RA that they are now developing.

The definition was first drafted using suggested terminology gathered from an international survey among rheumatologists. The task force—which included rheumatologists, nurses, health professionals, and patients—discussed and revised the draft, ultimately reaching sufficient agreement on the definition.

The task force determined that the following criteria compose the definition of difficult-to-treat RA and that all 3 need to be present to confirm the state of difficult-to-treat RA:

  1. Treatment failure history: treatment according to EULAR recommendations and failure of at least 2 biological disease-modifying antirheumatic drugs (DMARDs)/targeted synthetic DMARDs (with different mechanisms of action) after failing conventional synthetic DMARD therapy (unless contraindicated) 
  2. Characterization of active/symptomatic disease: presence of at least 1 of the following: 
    • At least moderate disease activity
    • Signs and/or symptoms suggestive of active disease
    • Inability to taper glucocorticoid treatment (below 7.5mg/day prednisone or equivalent)
    • Rapid radiographic progression (with or without signs of active disease)
    • RA symptoms that are causing a reduction in quality of life

      3. Clinical perception: the management of signs and/or symptoms is perceived as problematic by the rheumatologist and/or the patient

“A new management approach is necessary for [difficult-to-treat RA] patients, in which this treatment goal is not achieved,” the authors wrote. “Hopefully, the definition presented here will provide a robust and consistent identification of patients with [difficult-to-treat] RA. In addition, this definition can provide a platform to define a group of similar patients for research.”

—Colleen Murphy

Reference:

Nagy G, Roodenrijs NMT, Welsing PMJ, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. Published online October 1, 2020. doi:10.1136/annrheumdis-2020-217344