ArticleAnnals of the rheumatic diseases2021
EULAR definition of difficult-to-treat rheumatoid arthritis.
Article in Annals of the rheumatic diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 288 papers, 3 of them syntheses that pooled it.
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Who cites it
288 citing papers in PubMed, 3 syntheses or guidelines pooled it, 507 citations in OpenAlex.
- Therapeutic approaches for difficult-to-treat rheumatoid arthritis: a systematic literature review of current evidence.RMD open · 2026Pooled it
- Autologous haematopoietic stem cell transplantation for rheumatic diseases: best practice recommendations from the EBMT Practice Harmonization and Guidelines Committee.Bone marrow transplantation · 2025Guideline
- Efficacy and safety of current therapies for difficult-to-treat rheumatoid arthritis: a systematic review and network meta-analysis.Journal of translational medicine · 2024Pooled it
- Cost-utility analysis of longstanding exercise therapy versus usual care in people with rheumatoid arthritis and severe functional limitations.Scandinavian journal of rheumatology · 2025Trial
- Angiotensin-(1-7) attenuates collagen-induced arthritis and suppresses ferroptosis in THP-1-derived macrophages: involvement of p53/SLC7A11 signaling.Journal of molecular histology · 2026Article
- Clinical characteristics and associated factors of difficult-to-treat rheumatoid arthritis: a cross-sectional study.Clinical rheumatology · 2026Article
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- Difficult-to-treat, complex-to-manage, treatment-refractory spondyloarthritis: semantics or substance?Current opinion in rheumatology · 2026Review
- Real-world epidemiology and management of patients with rheumatoid arthritis treated with methotrexate in France: a decade after methotrexate first recommendations.EULAR rheumatology open · 2026Article
- Clinical and healthcare burden of difficult-to-treat rheumatoid arthritis in Japan: a retrospective cohort study.BMJ open · 2026Observational
- Effects of Eucommia ulmoides Oliv. on Key Nodes and Gene Expression in Wnt/β-Catenin Pathway in Collagen-Induced Arthritis Rats.Chinese journal of integrative medicine · 2026Article
- Association Between Fish Consumption and Minimal Disease Activity in Patients With Rheumatoid Arthritis Receiving Molecular-Targeted Therapies.International journal of rheumatic diseases · 2026Article
- Diagnostic, prognostic and therapeutic biomarkers in rheumatoid arthritis.Nature reviews. Rheumatology · 2026Review
- Splenic neuromodulation as monotherapy and in combination with biologic or targeted synthetic DMARDs for difficult-to-treat rheumatoid arthritis (ConsiderRAte): a randomised, sham-controlled, early feasibility trial.EClinicalMedicine · 2026Article
- Use of Artificial Intelligence in Rheumatoid Arthritis: Advancements and Novel Perspectives.Journal of clinical medicine · 2026Review
- Rare variants in genes related to inborn errors of immunity in patients with rheumatoid arthritis and secondary immunodeficiency.RMD open · 2026Article
- Targeting fibroblasts in immune mediated inflammatory diseases: a cellular basis for cure?Rheumatology (Oxford, England) · 2026Review
228 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
31 authors at 20 institutions in 13 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite treatment according to the current management recommendations, a significant proportion of patients with rheumatoid arthritis (RA) remain symptomatic. These patients can be considered to have 'difficult-to-treat RA'. However, uniform terminology and an appropriate definition are lacking.
objectiveThe Task Force in charge of the
methodsThe Steering Committee drafted a definition with suggested terminology based on an international survey among rheumatologists. This was discussed and amended by the Task Force, including rheumatologists, nurses, health professionals and patients, at a face-to-face meeting until sufficient agreement was reached (assessed through voting).
resultsThe following three criteria were agreed by all Task Force members as mandatory elements of the definition of difficult-to-treat RA: (1) Treatment according to European League Against Rheumatism (EULAR) recommendation and failure of ≥2 biological disease-modifying antirheumatic drugs (DMARDs)/targeted synthetic DMARDs (with different mechanisms of action) after failing conventional synthetic DMARD therapy (unless contraindicated); (2) presence of at least one of the following: at least moderate disease activity; signs and/or symptoms suggestive of active disease; inability to taper glucocorticoid treatment; rapid radiographic progression; RA symptoms that are causing a reduction in quality of life; and (3) the management of signs and/or symptoms is perceived as problematic by the rheumatologist and/or the patient.
conclusionsThe proposed EULAR definition for difficult-to-treat RA can be used in clinical practice, clinical trials and can form a basis for future research.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.