Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
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.
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.
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.
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.
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.
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 10). https://acrabstracts.org/abstract/characteristics-of-difficult-to-treat-rheumatoid-arthritis-results-of-an-international-survey/. Accessed January 20, 2020.
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