ArticleEULAR rheumatology open2026
Characterising subgroups of difficult-to-treat rheumatoid arthritis in real-world clinical settings.
Article in EULAR rheumatology open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 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
2 citing papers in PubMed.
- Emerging trends in the management of difficult-to-treat rheumatoid arthritis: targeted treatments and non-pharmacological interventions.Rheumatology (Oxford, England) · 2026Review
- Pathogenic Drivers of Difficult-to-Treat Rheumatoid Arthritis: Synovium and Beyond.International journal of molecular sciences · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objectives: To evaluate the proportion of persistent inflammatory refractory rheumatoid arthritis (PIRRA) and noninflammatory refractory rheumatoid arthritis (NIRRA) of difficult-to-treat rheumatoid arthritis (D2T-RA) using musculoskeletal ultrasound (MSUS) and to compare clinical characteristics across PIRRA, NIRRA, and disease-controlled refractory rheumatoid arthritis (RA) subgroups. Methods: A retrospective single-centre cohort study identified patients (May 2021 to December 2022) with inadequate response to ≥2 different mechanism of action biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) and disease activity score in 28 joints-erythrocyte sedimentation rate (ESR) of >3.2 as European Alliance of Associations for Rheumatology-defined D2T-RA. MSUS classified this group into PIRRA (power Doppler present) or NIRRA (no power Doppler synovitis). A comparator group of controlled refractory RA (≥2 b/tsDMARD failures but sustained low disease activity) was also assessed. Clinical data were collected and analysed. Results: Of the 85 patients, 45 had D2T-RA (25 [56%] PIRRA; 20 [44%] NIRRA), and 40 had controlled refractory RA. PIRRA subgroup had higher C-reactive protein (CRP), but NIRRA subgroup higher ESR. Fibromyalgia was more prevalent in PIRRA and NIRRA than that in controlled refractory RA (48%, 40%, and 17.5%, respectively; Conclusions: MSUS-based stratification of D2T-RA into PIRRA and NIRRA reveals distinct associations to CRP and ESR and comparable chronic pain. Subclinical inflammation is present even in ostensibly controlled disease, suggesting risk of re-falling into an active D2T-RA state. Identifying such subphenotypes can inform on monitoring strategies, support mechanistic investigation, and enable more targeted treatments to improve outcomes of D2T-RA.
Identifiers
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.