2023 Volume 83 Issue 3 Pages 175-180
The prognosis of rheumatoid arthritis （RA） has improved drastically due to the introduction of highly effective biologic agents and innovative molecular targeted therapies such as Janus kinase inhibitors. However, some RA patients still experience symptoms even when treated with currently proposed therapies and management methods. This type of RA is known as difficult-to-treat RA （D2T RA）. D2T RA is categorized into three types: 1） RA that is complex to discern, 2） RA that is complex to treat with intensified therapy, and 3） RA that is refractory even with intensified therapy. The RA refractory for intensified therapy was further classified into five categories: （1） adverse drug events, （2） poor adherence, （3） inadequate drug management, （4） complications, and （5） economic factors. Furthermore, RA that is refractory despite the intensified treatment is classified into the following four categories: （1） classification of refractory RA, （2） differentiation between inflammatory and non-inflammatory RA, （3） response to inflammatory refractory RA, and （4） response to non-inflammatory refractory RA. Each of these complications and their present solutions are outlined in this study.
