Department of Rheumatology, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary.
Ann Rheum Dis. 2021 Jan;80(1):31-35. doi: 10.1136/annrheumdis-2020-217344. Epub 2020 Oct 1.
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.
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.
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).
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.
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.
尽管根据当前的管理建议进行了治疗，但仍有相当一部分类风湿关节炎（RA）患者仍有症状。这些患者可以被认为是“难治性 RA”。然而，目前缺乏统一的术语和适当的定义。
负责制定“治疗难治性类风湿关节炎综合管理 EULAR 建议”的工作组旨在为这一未得到充分治疗的患者群体制定建议。在此，我们提出难治性 RA 的定义，作为第一步。
指导委员会根据风湿病学家的国际调查，起草了一个定义和建议的术语。该定义在一次面对面会议上进行了讨论和修订，该会议由工作组（包括风湿病学家、护士、卫生专业人员和患者）参加，直到达成足够的共识（通过投票评估）。
所有工作组的成员都同意以下三个标准是难治性 RA 定义的强制性要素：（1）根据欧洲抗风湿病联盟（EULAR）的建议进行治疗，在常规合成 DMARD 治疗失败后（除非有禁忌症），至少有 2 种生物性疾病修饰抗风湿药物（DMARDs）/靶向合成 DMARDs（具有不同的作用机制）治疗失败；（2）存在以下至少一项：至少中度疾病活动；有提示疾病活动的迹象和/或症状；无法减少糖皮质激素治疗；快速影像学进展；RA 症状导致生活质量下降；（3）风湿病学家和/或患者认为治疗迹象和/或症状存在问题。
提出的 EULAR 难治性 RA 定义可用于临床实践、临床试验，并可为未来的研究提供基础。
