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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788062/ https://www.ncbi.nlm.nih.gov/pubmed/33004335 http://dx.doi.org/10.1136/annrheumdis-2020-217344 |
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author | Nagy, György Roodenrijs, Nadia MT Welsing, Paco MJ Kedves, Melinda Hamar, Attila van der Goes, Marlies C Kent, Alison Bakkers, Margot Blaas, Etienne Senolt, Ladislav Szekanecz, Zoltan Choy, Ernest Dougados, Maxime Jacobs, Johannes WG Geenen, Rinie Bijlsma, Hans WJ Zink, Angela Aletaha, Daniel Schoneveld, Leonard van Riel, Piet Gutermann, Loriane Prior, Yeliz Nikiphorou, Elena Ferraccioli, Gianfranco Schett, Georg Hyrich, Kimme L Mueller-Ladner, Ulf Buch, Maya H McInnes, Iain B van der Heijde, Désirée van Laar, Jacob M |
author_facet | Nagy, György Roodenrijs, Nadia MT Welsing, Paco MJ Kedves, Melinda Hamar, Attila van der Goes, Marlies C Kent, Alison Bakkers, Margot Blaas, Etienne Senolt, Ladislav Szekanecz, Zoltan Choy, Ernest Dougados, Maxime Jacobs, Johannes WG Geenen, Rinie Bijlsma, Hans WJ Zink, Angela Aletaha, Daniel Schoneveld, Leonard van Riel, Piet Gutermann, Loriane Prior, Yeliz Nikiphorou, Elena Ferraccioli, Gianfranco Schett, Georg Hyrich, Kimme L Mueller-Ladner, Ulf Buch, Maya H McInnes, Iain B van der Heijde, Désirée van Laar, Jacob M |
author_sort | Nagy, György |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7788062 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-77880622021-01-14 EULAR definition of difficult-to-treat rheumatoid arthritis Nagy, György Roodenrijs, Nadia MT Welsing, Paco MJ Kedves, Melinda Hamar, Attila van der Goes, Marlies C Kent, Alison Bakkers, Margot Blaas, Etienne Senolt, Ladislav Szekanecz, Zoltan Choy, Ernest Dougados, Maxime Jacobs, Johannes WG Geenen, Rinie Bijlsma, Hans WJ Zink, Angela Aletaha, Daniel Schoneveld, Leonard van Riel, Piet Gutermann, Loriane Prior, Yeliz Nikiphorou, Elena Ferraccioli, Gianfranco Schett, Georg Hyrich, Kimme L Mueller-Ladner, Ulf Buch, Maya H McInnes, Iain B van der Heijde, Désirée van Laar, Jacob M Ann Rheum Dis Recommendation 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. BMJ Publishing Group 2021-01 2020-10-01 /pmc/articles/PMC7788062/ /pubmed/33004335 http://dx.doi.org/10.1136/annrheumdis-2020-217344 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Recommendation Nagy, György Roodenrijs, Nadia MT Welsing, Paco MJ Kedves, Melinda Hamar, Attila van der Goes, Marlies C Kent, Alison Bakkers, Margot Blaas, Etienne Senolt, Ladislav Szekanecz, Zoltan Choy, Ernest Dougados, Maxime Jacobs, Johannes WG Geenen, Rinie Bijlsma, Hans WJ Zink, Angela Aletaha, Daniel Schoneveld, Leonard van Riel, Piet Gutermann, Loriane Prior, Yeliz Nikiphorou, Elena Ferraccioli, Gianfranco Schett, Georg Hyrich, Kimme L Mueller-Ladner, Ulf Buch, Maya H McInnes, Iain B van der Heijde, Désirée van Laar, Jacob M EULAR definition of difficult-to-treat rheumatoid arthritis |
title | EULAR definition of difficult-to-treat rheumatoid arthritis |
title_full | EULAR definition of difficult-to-treat rheumatoid arthritis |
title_fullStr | EULAR definition of difficult-to-treat rheumatoid arthritis |
title_full_unstemmed | EULAR definition of difficult-to-treat rheumatoid arthritis |
title_short | EULAR definition of difficult-to-treat rheumatoid arthritis |
title_sort | eular definition of difficult-to-treat rheumatoid arthritis |
topic | Recommendation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788062/ https://www.ncbi.nlm.nih.gov/pubmed/33004335 http://dx.doi.org/10.1136/annrheumdis-2020-217344 |
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