ReviewRMD open2022
'Difficult to treat' rheumatoid arthritis: current position and considerations for next steps.
Review in RMD open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05671627 (An Impaired Functional Reserve of Adrenal Cortex May Associate With difficult-to Treat RA), which is not on this map. Cited by 38 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
An Impaired Functional Reserve of Adrenal Cortex May Associate With difficult-to Treat RA: Can a Disturbed Cortisol Circadian Rhythm Serve as a Predictor of Difficult-to-treat RA?
Who cites it
38 citing papers in PubMed, 70 citations in OpenAlex.
- Beyond Pain Intensity: Central Sensitization and Psychosocial Symptom Burden in Women with Rheumatoid Arthritis.Medicina (Kaunas, Lithuania) · 2026Observational
- Review
- Macrophage metabolic exhaustion and PANoptotic cell death drive chronic tissue inflammation in rheumatoid arthritis.Immunity · 2026Article
- Lipid droplet-induced T cell death sustains autoimmune tissue inflammation.Cell metabolism · 2026Article
- Cardiovascular and Thromboembolic Risk of Janus Kinase Inhibitors Compared to Other Disease-Modifying Drugs in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.Journal of personalized medicine · 2026Review
- The role of lactate on arthritis-associated cells: physiology, pathology, and therapeutic strategies.Cellular and molecular life sciences : CMLS · 2026Review
- Predicting rapid radiographic progression in difficult-to-treat rheumatoid arthritis: insights from long-term follow-up.Rheumatology (Oxford, England) · 2026Article
- Development and External Validation of a Multivariable Predictive Model for Progression to Difficult-to-Treat Rheumatoid Arthritis in Biologic-Experienced Patients.Arthritis care & research · 2026Article
- Qingre Huoxue decoction and its active compound Quercetin modulate bone remodeling by inhibiting ATF4 hyperactivation to attenuate bone erosion in rheumatoid arthritis.Journal of orthopaedic surgery and research · 2025Article
- Nanocarriers Containing Curcumin and Derivatives for Arthritis Treatment: Mapping the Evidence in a Scoping Review.Pharmaceutics · 2025Review
- Rituximab, Apremilast, and Upadacitinib as Selected Biosimilar and Targeted Synthetic Disease-Modifying Antirheumatic Drugs with Diverse Mechanisms of Action: Their Current Use in Slowing Down the Progression of Disease.Journal of clinical medicine · 2025Review
- Rheumatoid arthritis severity is mediated by crosstalk between synoviocytes and mature osteoclasts through a calcium and cytokine feedback loop.Experimental & molecular medicine · 2025Article
- Obesity and fibromyalgia are associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) independent of age and gender.Arthritis research & therapy · 2025Article
- Effectiveness of ultrasound-guided intra-articular drug injections in treating sternoclavicular arthritis: a single-group observational study.Quantitative imaging in medicine and surgery · 2025Article
- Rheumatoid Arthritis and Fibromyalgia Syndrome: A Bibliometric and Bioinformatics Perspective on Comorbidity Research.Journal of multidisciplinary healthcare · 2025Article
- [Research progress on the role of dendritic cells in immune metabolism of rheumatoid arthritis].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2024Review
- Difficult to Treat Psoriatic Arthritis: The Road So Far.Mediterranean journal of rheumatology · 2024Review
- Timely escalation to second-line therapies after failure of methotrexate in patients with early rheumatoid arthritis does not reduce the risk of becoming difficult-to-treat.Arthritis research & therapy · 2024Article
- The potential role of fatigue in difficult-to-treat rheumatoid arthritis.BMC rheumatology · 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
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The European Alliance of Associations for Rheumatology recently defined difficult to treat (D2T) rheumatoid arthritis (RA) and provided points to consider in its management. This review summarises the key concepts of D2T-RA that underpinned this recent guidance. D2T-RA is primarily characterised by failure of at least two different mechanism of action biologic/targeted synthetic disease-modifying antirheumatic drug (DMARDs) with evidence of active/progressive disease. The basis for progressive disease, however, is not limited to clear inflammatory joint pathology, capturing wider contributors to treatment cycling such as comorbidity, obesity and fibromyalgia. This means D2T-RA comprises a heterogeneous population, with a proportion within this exhibiting bona fide treatment-refractory disease. The management points to consider, however, emphasise the importance of checking for the presence of inflammatory pathology before further treatment change. This review suggests additional considerations in the definition of D2T-RA, the potential value in identifying D2T traits and intervening before the development of D2T-RA state and the need for real world evidence of targeted synthetic DMARD in this population to compare to recent trial data. Finally, the review asks whether the presence of D2T-RA implies a failure to treat effectively from the outset, and the need for pharmacological and non-pharmacological management approaches to address the wider D2T-RA population effectively.
Indexed as
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What OpenQuestion holds
Registered trials
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.