Research Agenda
Many questions remain with respect to the research agenda and what is on the horizon for this theme. Potential research questions include: How can clinicians optimally confirm the RA diagnosis in patients with difficult-to-treat disease? What is the role of synovial biopsies in assessing the presence or absence of inflammation in difficult-to-treat disease? Which biologic and targeted synthetic DMARDs may be most effective in treating the majority of these patients? Could the development of the difficult-to-treat state be prevented by adequate management of contributing factors early in the course of disease? How do common issues, such as obesity and smoking, impact these patients long term?
Dr. van Laar explained that because the definition of difficult-to-treat disease has only recently been formalized, much is still to be learned about patients who fit this category. In addition, it is important that research studies use case definitions appropriately so the results may be generalizable to similar patients in the real world.
In Sum
At the end of the lecture, Dr. van Laar stressed the traits, comorbidities and elements of care associated with difficult-totreat disease are varied and multifactorial, thus a holistic approach to care is important. It is essential to remember that difficult-to-treat disease is not end-stage or irreversible and that creativity, collaboration and good communication with patients are key to helping patients meet their goals.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Pollard LC, Kingsley GH, Choy EH, Scott DL. Fibromyalgic rheumatoid arthritis and disease assessment. Rheumatology (Oxford). 2010 May;49(5):924–928.
- Nagy G, Roodenrijs NMT, Welsing PM, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021 Jan;80(1):31–35.
- Roodenrijs NMT, van der Goes MC, Welsing PMJ, et al. Difficult-to-treat rheumatoid arthritis: Contributing factors and burden of disease. Rheumatology (Oxford). 2021 Aug 2;60(8):3778–3788.
