Characteristics of Difficult-to-Treat Rheumatoid Arthritis: Results of an International Survey

Nadia MT Roodenrijs¹, Maria JH de Hair¹, Marlies C van der Goes¹, Johannes W. G. Jacobs¹, Paco MJ Welsing¹, Désirée van der Heijde², Daniel Aletaha³, Maxime Dougados⁴, Kimme L. Hyrich⁵, Iain B. McInnes⁶, Ulf Müller-Ladner⁷, Ladislav Šenolt⁸, Zoltan Szekanecz⁹, Jacob van Laar¹ and Gyorgy Nagy¹⁰, ¹Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands, Utrecht, Netherlands, ²Leiden University Medical Centre, Leiden, Netherlands, ³Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria, Vienna, Austria, ⁴Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France, Paris, France, ⁵Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, United Kingdom, ⁶Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK, Glasgow, United Kingdom, ⁷Dept. of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Germany, Bad Nauheim, Germany, ⁸First Faculty of Medicine, Charles University, Prague, Czech Republic, Prague, Czech Republic, ⁹Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary, Debrecen, Hungary, ¹⁰Department of Genetics, Cell- and Immunobiology & Department of Rheumatology, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary, Budapest, Hungary

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Disease Activity, Rheumatoid arthritis (RA), treatment, treatment guidlelines and treatment options

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:
EULAR and ACR recommendations on the management of rheumatoid arthritis (RA) mainly focus on early RA and medication.^1,2 Following these recommendations, several patients nevertheless remain symptomatic, which makes them difficult-to-treat.³ The estimated prevalence of difficult-to-treat RA ranges from 5 to 20%.⁴ A difficult-to-treat RA classification would enable making recommendations on its comprehensive management. We aimed to identify characteristics of difficult-to-treat RA and issues to be addressed in its comprehensive workup and management that are not covered by the current RA management recommendations.

Methods:
Among rheumatologists, an international survey was conducted. It included multiple-choice questions on disease characteristics of difficult-to-treat RA and open questions on additional items to be addressed and items missing in current management recommendations.

Results:
410 rheumatologists (a few of them in training) from 33 countries, mostly in Europe, completed the survey between July 2017 and March 2018 (Figure 1a). For disease characteristics of difficult-to-treat RA, 50% of respondents selected disease activity score assessing 28 joints (DAS28) >3.2 OR signs suggestive of active disease; 42% selected fatigue; 48% selected failure to ³2 conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) AND ³2 biological/targeted synthetic DMARDs; 89% selected inability to taper glucocorticoids below 5 or 10 mg prednisone equivalent daily (Figure 1b). Over 400 responses to the open questions were received (Figure 2). Comorbidities, extra-articular manifestations and polypharmacy were identified as important issues missing in current management recommendations.

Conclusion:
Concepts of difficult-to-treat RA vary considerably. Important issues regarding patients with difficult-to-treat RA, such as comorbidities, extra-articular manifestations and polypharmacy, are not addressed by current RA management recommendations.

References
1 Smolen JS, et al. Ann Rheum Dis 2017;76:960-77.
2 Singh JA, et al. Arthritis Rheum 2016;68:1-26.
3 de Hair MJH, et al. Rheumatology (Oxford) 2017.[Epub]
4 Kearsley-Fleet L, et al. Ann Rheum Dis 2017;76:960–77.

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$Description: O:\Reumatologie\Difficult to treat RA (Nadia)\4. Survey DtT RA\Abstract ACR\ACR abstract Figure 2.png$

Disclosure: N. M. Roodenrijs, None; M. J. de Hair, None; M. C. van der Goes, None; J. W. G. Jacobs, None; P. M. Welsing, None; D. van der Heijde, Imaging Rheumatology BV, 3,AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi and UCB Pharma, 5; D. Aletaha, None; M. Dougados, None; K. L. Hyrich, None; I. B. McInnes, None; U. Müller-Ladner, None; L. Šenolt, AbbVie, BMS, Celgene Corporation, Eli Lilly, Merck Sharp and Dohme, Novartis, Pfizer, Roche, Takeda, UCB, 5; Z. Szekanecz, None; J. van Laar, Arthrogen, MSD, Pfizer, Eli Lelly, BMS, Astra Zeneca, Roche-Genentech, 2, 5; G. Nagy, Amgen, AbbVie, BMS, KRKA, MSD, Pfizer, Roche, UCB, 2.

To cite this abstract in AMA style:

Roodenrijs NM, de Hair MJ, van der Goes MC, Jacobs JWG, Welsing PM, van der Heijde D, Aletaha D, Dougados M, Hyrich KL, McInnes IB, Müller-Ladner U, Šenolt L, Szekanecz Z, van Laar J, Nagy G. Characteristics of Difficult-to-Treat Rheumatoid Arthritis: Results of an International Survey [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/characteristics-of-difficult-to-treat-rheumatoid-arthritis-results-of-an-international-survey/. Accessed .

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