ReviewDrugs2020
Understanding Refractory Rheumatoid Arthritis: Implications for a Therapeutic Approach.
Review in Drugs, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed.
- Neither ultrasound synovitis nor clinical-ultrasound phenotypes of established rheumatoid arthritis predict response to targeted therapy.Rheumatology (Oxford, England) · 2025Observational
- Synovial matrix turnover controls immune cell spatial patterning in inflammation resolution.Molecular systems biology · 2025Article
- Precision medicine in rheumatoid arthritis-associated interstitial lung disease: current evidence and future directions.Current opinion in pulmonary medicine · 2025Review
- Investigating the mechanism of Gentiopicroside in rheumatoid arthritis through network pharmacology, molecular docking, and experimental validation.Scientific reports · 2025Article
- Inflammatory and angiogenic serum profile of refractory rheumatoid arthritis.Scientific reports · 2025Article
- Machine learning-based prediction of response to Janus kinase inhibitors in patients with rheumatoid arthritis using clinical data.Frontiers in immunology · 2025Article
- Advanced Targeted Therapy for Colorectal Cancer with Lipid Nanoparticles.Current medicinal chemistry · 2025Review
- Allogeneic bone marrow derived clonal mesenchymal stromal cells in refractory rheumatoid arthritis: a pilot study.Regenerative medicine · 2024Article
- Truth unveiled by time and the marbled definition of D2T-RA: retrospective analysis on the persistence of the difficult-to-treat status among refractory RA patients.Arthritis research & therapy · 2024Article
- Reasons for multiple biologic and targeted synthetic DMARD switching and characteristics of treatment refractory rheumatoid arthritis.Seminars in arthritis and rheumatism · 2024Article
- Management of refractory disease and persistent symptoms in inflammatory arthritis: qualitative framework analysis of interviews with patients and healthcare professionals.Rheumatology advances in practice · 2024Article
- Involvement of Epithelial-Mesenchymal Transition (EMT) in Autoimmune Diseases.International journal of molecular sciences · 2023Review
- Clinical Features of Diabetes Mellitus on Rheumatoid Arthritis: Data from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group.Journal of clinical medicine · 2023Article
- Article
- Where traditional Chinese medicine meets Western medicine in the prevention of rheumatoid arthritis.Journal of internal medicine · 2022Review
- Predictive value of drug efficacy by M6A modification patterns in rheumatoid arthritis patients.Frontiers in immunology · 2022Article
- Managing inadequate response to initial anti-TNF therapy in rheumatoid arthritis: optimising treatment outcomes.Therapeutic advances in musculoskeletal disease · 2022Review
- Intra-articular use of radium dichloride ([European journal of nuclear medicine and molecular imaging · 2021Article
- Mitochondria as Key Players in the Pathogenesis and Treatment of Rheumatoid Arthritis.Frontiers in immunology · 2021Review
- Critical Role of Synovial Tissue-Resident Macrophage and Fibroblast Subsets in the Persistence of Joint Inflammation.Frontiers in immunology · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Refractory rheumatoid arthritis (RA) has emerged as an area of unmet need in a landscape of generally well-controlled disease. Whilst most patients are adequately treated on methotrexate and other first-line disease-modifying anti-rheumatic drugs (DMARDs), a proportion requires biologic (b) and targeted synthetic (ts) DMARDs, with a further subsection failing multiple agents. Recent observational studies have adopted working definitions of refractory RA based on number of failed DMARDs, with prevalence estimates of 6-21% depending on threshold and study population. Risk factors include treatment delay, baseline disease activity and function, female gender, smoking, obesity and lower socioeconomic status. Practical and conceptual challenges in defining refractory RA arise from limitations of disease activity scores used to assess response, with attendant misclassification risk of co-existent non-inflammatory pathology, and failure to capture additional outcomes, such as fatigue, that have variable treatment response. Time is an important factor in defining refractory disease; registry studies show that growing treatment options have resulted in rapid b/tsDMARD cycling and earlier refractory status, and refractory RA is itself a dynamic concept, evolving with each new therapeutic class. Whilst the biology underpinning refractory RA remains largely unknown, a general overview of biomarker studies and clinical trials old and new offers insights into prediction of response and treatment failure. Whilst the future holds promise, current data are insufficient to personalise or meaningfully sequence b/tsDMARDs. Therefore, avoidance of a refractory course is best achieved by following proven management paradigms (e.g. early diagnosis and treat-to-target), addressing modifiable risk factors, and considering enrolment in novel trials.
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Registered trials
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