Difficult-to-Treat RA Definition & Management Considerations

Lastly, the PtCs encourage the use of non-pharmacological modalities like exercise, psychological interventions (e.g., cognitive behavioral therapy) and education in all patients with D2T RA.¹³ Increasing self-efficacy—the ability to control or manage various aspects of their disease—profoundly impacts the well-being of patients.¹⁴ 

Professor Nagy says, “Non-pharmacological therapy, self-management programs and exercise are essential in RA. Clearly, more well-designed trials are needed [in this regard] too.”

High-quality evidence to guide recommendations was scarce, leading to low strength of recommendations. But the Task Force proposed an agenda to help guide further research. Professor Nagy states, “The definition is new. D2T RA is a whole new entity. We hope that there will be significant interest regarding our work, and that our proposal will be used in daily clinical practice and promote further research.”

Conclusion

EULAR has taken an important step forward in improving the care of our patients with D2T RA. A standardized definition may inform future clinical trials, and evidence-based guidance for the care of this population may lead to improved outcomes. Professor Nagy concludes, “This is the major message of our work: avoid overtreatment [and also overdiagnosis])!”

Samantha C. Shapiro, MD, is an academic rheumatologist and an affiliate faculty member of the Dell Medical School at the University of Texas at Austin. She is a member of the ACR Insurance Subcommittee.

References

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