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Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems

Over the past several decades, the treatment of rheumatoid arthritis (RA) has advanced significantly, and clinical, structural, and functional remission are achievable therapeutic goals. However, a substantial number of patients show resistance to multiple drugs. In particular, patients whose diseas...

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Autores principales: Watanabe, Ryu, Okano, Tadashi, Gon, Takaho, Yoshida, Naofumi, Fukumoto, Kazuo, Yamada, Shinsuke, Hashimoto, Motomu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637686/
https://www.ncbi.nlm.nih.gov/pubmed/36353219
http://dx.doi.org/10.3389/fmed.2022.1049875
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author Watanabe, Ryu
Okano, Tadashi
Gon, Takaho
Yoshida, Naofumi
Fukumoto, Kazuo
Yamada, Shinsuke
Hashimoto, Motomu
author_facet Watanabe, Ryu
Okano, Tadashi
Gon, Takaho
Yoshida, Naofumi
Fukumoto, Kazuo
Yamada, Shinsuke
Hashimoto, Motomu
author_sort Watanabe, Ryu
collection PubMed
description Over the past several decades, the treatment of rheumatoid arthritis (RA) has advanced significantly, and clinical, structural, and functional remission are achievable therapeutic goals. However, a substantial number of patients show resistance to multiple drugs. In particular, patients whose disease activity cannot be controlled despite the use of two or more biological disease-modifying antirheumatic drugs (DMARDs) or targeted synthetic DMARDs (tsDMARDs) with different mechanisms of action (MOA) have recently been referred to as having difficult-to-treat RA (D2T RA). D2T RA is a heterogeneous and multifactorial disease state, and the major problems are uncontrolled disease activity and decreased quality of life, as well as the economic burden due to frequent healthcare utilization and multiple admissions. Since the concept of D2T RA is relatively new and publication regarding D2T RA is limited, the mechanism underlying DMARD inefficacy and which factors form a “difficult-to-treat” state in such patients are not yet fully understood. It is also possible that factors contributing to D2T RA may differ by patient, sex, country, and race. The present Mini Review introduces the current concept and unsolved problems of D2T RA, including the definition, prevalence, and factors contributing to D2T RA. We then discuss the management and therapeutic strategies for D2T RA. Finally, we explore a clinical approach to prevent patients from developing D2T RA.
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spelling pubmed-96376862022-11-08 Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems Watanabe, Ryu Okano, Tadashi Gon, Takaho Yoshida, Naofumi Fukumoto, Kazuo Yamada, Shinsuke Hashimoto, Motomu Front Med (Lausanne) Medicine Over the past several decades, the treatment of rheumatoid arthritis (RA) has advanced significantly, and clinical, structural, and functional remission are achievable therapeutic goals. However, a substantial number of patients show resistance to multiple drugs. In particular, patients whose disease activity cannot be controlled despite the use of two or more biological disease-modifying antirheumatic drugs (DMARDs) or targeted synthetic DMARDs (tsDMARDs) with different mechanisms of action (MOA) have recently been referred to as having difficult-to-treat RA (D2T RA). D2T RA is a heterogeneous and multifactorial disease state, and the major problems are uncontrolled disease activity and decreased quality of life, as well as the economic burden due to frequent healthcare utilization and multiple admissions. Since the concept of D2T RA is relatively new and publication regarding D2T RA is limited, the mechanism underlying DMARD inefficacy and which factors form a “difficult-to-treat” state in such patients are not yet fully understood. It is also possible that factors contributing to D2T RA may differ by patient, sex, country, and race. The present Mini Review introduces the current concept and unsolved problems of D2T RA, including the definition, prevalence, and factors contributing to D2T RA. We then discuss the management and therapeutic strategies for D2T RA. Finally, we explore a clinical approach to prevent patients from developing D2T RA. Frontiers Media S.A. 2022-10-24 /pmc/articles/PMC9637686/ /pubmed/36353219 http://dx.doi.org/10.3389/fmed.2022.1049875 Text en Copyright © 2022 Watanabe, Okano, Gon, Yoshida, Fukumoto, Yamada and Hashimoto. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Watanabe, Ryu
Okano, Tadashi
Gon, Takaho
Yoshida, Naofumi
Fukumoto, Kazuo
Yamada, Shinsuke
Hashimoto, Motomu
Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems
title Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems
title_full Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems
title_fullStr Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems
title_full_unstemmed Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems
title_short Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems
title_sort difficult-to-treat rheumatoid arthritis: current concept and unsolved problems
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637686/
https://www.ncbi.nlm.nih.gov/pubmed/36353219
http://dx.doi.org/10.3389/fmed.2022.1049875
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