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Rheumatologists Vary Widely on Defining Traits of Hard-to-treat RA
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The results of an international, EULAR task force survey indicate that rheumatologists varied widely on the identifiable characteristics of difficult-to-treat rheumatoid arthritis, according to findings published in the Annals of the Rheumatic Diseases.
“EULAR recommendations and the American College of Rheumatology guidelines on management of RA focus on early phases of the disease and on pharmacological management,” Nadia M.T. Roodenrijs, a PhD candidate at the University Medical Center Utrecht, the Netherlands, and colleagues wrote. “Nevertheless, a significant proportion of patients remains symptomatic after several cycles of treatment, which makes them difficult to treat; this is a significant clinical problem in daily practice.”
To identify characteristics and problems in the management of difficult-to-treat RA that are not currently addressed in EULAR recommendations, the researchers developed an international survey that was sent via email to rheumatologists, and those in training, throughout authors’ networks and the Emerging EULAR Network.
The survey included questions about disease characteristics of difficult-to-treat RA, including disease activity level, fatigue, the number of disease-modifying antirheumatic drugs that have failed and the inability to taper treatment with glucocorticoids. In addition, the researchers included three open questions asking respondents to include any other characteristics, criteria, clinical issues, comorbidities or situations relevant to hard-to-treat RA that are not included in current EULAR recommendations.
According to the researchers, among the 410 respondents from 33 countries, 89% selected an inability to taper glucocorticoid treatment below 5 mg, 10 mg prednisone equivalent daily as characteristics of hard-to-treat RA. Half selected a DAS28 of more than 3.2, or the presence of signs suggestive of active disease, as characteristics of difficult-to-treat rheumatoid arthritis. In addition, 48% chose the failure of two or more conventional synthetic DMARDs and at least two biological/targeted synthetic DMARDs, and 42% named fatigue. In the open-ended questions, rheumatologists said interfering comorbidities, extra-articular manifestations and polypharmacy were important issues missing in current EULAR management recommendations.
“The results of this survey underscore the difficulty in establishing an unambiguous concept of difficult-to-treat RA, which is seen as a heterogeneous condition not fully covered by current EULAR recommendations,” Roodenrijs and colleagues wrote. “The recently established EULAR task force will explore the management of difficult-to-treat RA further.” – by Jason Laday
Disclosure: Roodenrijs reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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