EULAR definition of difficult-to-treat rheumatoid arthritis

György Nagy; Nadia M T Roodenrijs; Paco M J  Welsing; Melinda Kedves; Attila Hamar; Marlies C van der Goes; Alison  Kent; Margot Bakkers; Etienne Blaas; Ladislay Senolt; Zoltan  Szekanecz; Ernest  Choy; Maxime Dougados; Johannes W G  Jacobs; Rinie Geenen; Johannes W J  Bijlsma; Angela Zink; Daniel  Aletaha; Leonard Schoneveld; Piet van Riel; Loriane Gutermann; Yeliz Prior; Elena Nikiphorou; Gianfranco Ferraccioli; Georg Schett; Kimme Hyrich; Ulf Müller-Ladner; Maya Buch; Ian B McInnes; Désirée van der Heijde; Jacob M van  Laar

EULAR definition of difficult-to-treat rheumatoid arthritis

György Nagy, Nadia M T Roodenrijs, Paco M J Welsing, Melinda Kedves, Attila Hamar, Marlies C van der Goes, Alison Kent, Margot Bakkers, Etienne Blaas, Ladislay Senolt, Zoltan Szekanecz, Ernest Choy , Maxime Dougados, Johannes W G Jacobs, Rinie Geenen, Johannes W J Bijlsma, Angela Zink, Daniel Aletaha, Leonard Schoneveld, Piet van RielLoriane Gutermann, Yeliz Prior, Elena Nikiphorou, Gianfranco Ferraccioli, Georg Schett, Kimme Hyrich, Ulf Müller-Ladner, Maya Buch, Ian B McInnes, Désirée van der Heijde, Jacob M van Laar

Division of Musculoskeletal & Dermatological Sciences (L5)

Research output: Contribution to journal › Article › peer-review

Abstract

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 EULAR rec-ommendation and failure of ≥2 b/tsDMARDs (with different mechanisms of action) after failing csDMARD therapy (unless contraindicated); 2) presence of at least one of the follow-ing: 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; 3) the management of signs and/or symptoms is per-ceived 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.

Original language	English
Journal	Annals of the rheumatic diseases
Publication status	Accepted/In press - 6 Aug 2020

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Buch revised D2T definition manuscript
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Nagy, G., Roodenrijs, N. M. T., Welsing, P. M. J., Kedves, M., Hamar, A., Goes, M. C. V. D., Kent, A., Bakkers, M., Blaas, E., Senolt, L., Szekanecz, Z., Choy , E., Dougados, M., Jacobs, J. W. G., Geenen, R., Bijlsma, J. W. J., Zink, A., Aletaha, D., Schoneveld, L., ... Laar, J. M. V. (Accepted/In press). EULAR definition of difficult-to-treat rheumatoid arthritis. Annals of the rheumatic diseases.

@article{026cb2e0bcb946e48c55833da8aec17a,

title = "EULAR definition of difficult-to-treat rheumatoid arthritis",

abstract = "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 {\textquoteleft}difficult-to-treat RA{\textquoteright}. 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 EULAR rec-ommendation and failure of ≥2 b/tsDMARDs (with different mechanisms of action) after failing csDMARD therapy (unless contraindicated); 2) presence of at least one of the follow-ing: 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; 3) the management of signs and/or symptoms is per-ceived 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. ",

author = "Gy{\"o}rgy Nagy and Roodenrijs, {Nadia M T} and Welsing, {Paco M J} and Melinda Kedves and Attila Hamar and Goes, {Marlies C van der} and Alison Kent and Margot Bakkers and Etienne Blaas and Ladislay Senolt and Zoltan Szekanecz and Ernest Choy and Maxime Dougados and Jacobs, {Johannes W G} and Rinie Geenen and Bijlsma, {Johannes W J} and Angela Zink and Daniel Aletaha and Leonard Schoneveld and Riel, {Piet van} and Loriane Gutermann and Yeliz Prior and Elena Nikiphorou and Gianfranco Ferraccioli and Georg Schett and Kimme Hyrich and Ulf M{\"u}ller-Ladner and Maya Buch and McInnes, {Ian B} and Heijde, {D{\'e}sir{\'e}e van der} and Laar, {Jacob M van}",

year = "2020",

month = aug,

day = "6",

language = "English",

journal = "Annals of the rheumatic diseases",

issn = "0003-4967",

publisher = "Elsevier BV",

}

Nagy, G, Roodenrijs, NMT, Welsing, PMJ, Kedves, M, Hamar, A, Goes, MCVD, Kent, A, Bakkers, M, Blaas, E, Senolt, L, Szekanecz, Z, Choy , E, Dougados, M, Jacobs, JWG, Geenen, R, Bijlsma, JWJ, Zink, A, Aletaha, D, Schoneveld, L, Riel, PV, Gutermann, L, Prior, Y, Nikiphorou, E, Ferraccioli, G, Schett, G, Hyrich, K, Müller-Ladner, U, Buch, M, McInnes, IB, Heijde, DVD & Laar, JMV 2020, 'EULAR definition of difficult-to-treat rheumatoid arthritis', Annals of the rheumatic diseases.

TY - JOUR

T1 - EULAR definition of difficult-to-treat rheumatoid arthritis

AU - Nagy, György

AU - Roodenrijs, Nadia M T

AU - Welsing, Paco M J

AU - Kedves, Melinda

AU - Hamar, Attila

AU - Goes, Marlies C van der

AU - Kent, Alison

AU - Bakkers, Margot

AU - Blaas, Etienne

AU - Senolt, Ladislay

AU - Szekanecz, Zoltan

AU - Choy , Ernest

AU - Dougados, Maxime

AU - Jacobs, Johannes W G

AU - Geenen, Rinie

AU - Bijlsma, Johannes W J

AU - Zink, Angela

AU - Aletaha, Daniel

AU - Schoneveld, Leonard

AU - Riel, Piet van

AU - Gutermann, Loriane

AU - Prior, Yeliz

AU - Nikiphorou, Elena

AU - Ferraccioli, Gianfranco

AU - Schett, Georg

AU - Hyrich, Kimme

AU - Müller-Ladner, Ulf

AU - Buch, Maya

AU - McInnes, Ian B

AU - Heijde, Désirée van der

AU - Laar, Jacob M van

PY - 2020/8/6

Y1 - 2020/8/6

N2 - 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 EULAR rec-ommendation and failure of ≥2 b/tsDMARDs (with different mechanisms of action) after failing csDMARD therapy (unless contraindicated); 2) presence of at least one of the follow-ing: 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; 3) the management of signs and/or symptoms is per-ceived 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.

AB - 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 EULAR rec-ommendation and failure of ≥2 b/tsDMARDs (with different mechanisms of action) after failing csDMARD therapy (unless contraindicated); 2) presence of at least one of the follow-ing: 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; 3) the management of signs and/or symptoms is per-ceived 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.

M3 - Article

SN - 0003-4967

JO - Annals of the rheumatic diseases

JF - Annals of the rheumatic diseases

ER -

EULAR definition of difficult-to-treat rheumatoid arthritis

Abstract

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