VIDEO: Highlights in RA from EULAR 2022

Editor’s note: This is a previously posted video, and the below is an automatically generated transcript to be used for informational purposes. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

I attended the EULAR Meeting 2022 Convergence recently. And there is a lot of buzz about all the things that are going on with rheumatoid arthritis. First of all, there's new guidelines. And the guidelines are building onto the old guidelines from a couple of years ago. But one of the biggest differences is that they acknowledge that it's okay to use steroids short-term. And this is so different from the American College of Rheumatology guidelines, because the American College of Rheumatology guidelines says that, "If at all possible, avoid steroids. Don't use it, don't do it, because the risk is so damaging." But with the EULAR guidelines, they say, "You know what, we acknowledge the fact that sometimes our disease-modifying drugs can take weeks to months to kick in. So during this period of time, if the patient is hurting, it's okay to use a small amount of steroids. But try to limit it. Use it for a short time, then stop it." So that actually is in-line with what a lot of rheumatologists are doing in the community. The other thing that was presented at the EULAR meeting is that they also notice and acknowledge a whole group of rheumatoid arthritis patients. These are difficult-to-treat rheumatoid arthritis patients. They call them D2T RA, difficult to treat. And the definition of difficult to treat are patients who've already failed conventional synthetic DMARDs. So this is like methotrexate, sulfasalazine, leflunomide. But not only that, they've failed two biologics or targeted synthetic therapies. So that could be anything from etanercept, infliximab, or abatacept, and also like a JAK inhibitor. And then, these patients still had pretty significant high disease activity score, a DAS score of an ESR grade, DAS28 ESR greater than 3.2. They may still have high Sed Rate and CRP. They also have had signs and symptoms of progressive disease. So how do we treat these patients? It's about 10% of all rheumatoid arthritis patients. Well, what they're saying is that these patients possibly need to be reevaluated. Perhaps there's a misdiagnosis. Maybe there is a non-adherence issue. Like if a patient's not taking it or can't afford their medicine, maybe that's why they're difficult to treat. Or maybe you just totally have, it's not really rheumatoid arthritis activity that's causing their pain. It could be their comorbidities. Or maybe the patient needs an escalation in therapy. But one of the things that they found about the D2T RA population is that the highest risk factor for this is actually low socioeconomic class. It's not about age. It's not whether or not it's ACPA positive. It's not whether or not they're females, but typically they have a low socioeconomic status. In addition, this group of patients tend to have a lot more comorbidities. There's higher rate of cardiovascular disease, higher rates of depression, and higher rates of healthcare utilization. So we are now acknowledging there is a population of patients who are very difficult to treat.