Definition, characteristics, and management of difficult-to-treat RA

Abstract

Difficult-to-treat rheumatoid arthritis（D2T RA）is a new concept that refers to patients with RA whose symptoms have not improved after several treatments, resulting in a high patient and economic burden. The European League of Rheumatology（EULAR）defined D2T RA as having all three criteria:（1）a history of treatment failure, （2）characterization of active/symptomatic disease, and（3）clinical perception. D2T RA is reported to occur in around 5-10% of RA patients, and patients continue to suffer from symptoms that directly affect their social life, ability to work, and quality of life, as well as incurring higher annual medical costs than non-D2T RA patients. The clinical background that might influence D2T RA includes complications such as respiratory and cardiovascular problems, pain syndromes such as fibromyalgia and osteoarthritis, smoking, obesity, and depression. Patient education, physical exercise, psychological interventions, enhanced patient care, and enhanced communication with health care professionals are the basis of treatment, and each patient needs to optimize treatment through drug selection based on past drug history and mode of action, and orthopedic interventions.