Background Despite 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. Objective The Task Force in charge of the “Development of EULAR recommendations for the comprehensive management of difficult-to-treat rheumatoid arthritis” aims to create recommendations for this underserved patient group. Herein, we present the definition of difficult-to-treat RA, as the first step. Methods The 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). Results The 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. Conclusions The proposed EULAR definition for difficult-to-treat RA can be used in clinical practice, clinical trials and can form a basis for future research.

中文翻译：

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EULAR 对难治性类风湿性关节炎的定义

背景 尽管根据当前的管理建议进行了治疗，但仍有相当一部分类风湿性关节炎 (RA) 患者存在症状。这些患者可被认为患有“难治性类风湿性关节炎”。然而，缺乏统一的术语和适当的定义。目标 负责“为难治性类风湿性关节炎的综合管理制定 EULAR 建议”的工作组旨在为这一服务不足的患者群体制定建议。在此，我们提出难治性 RA 的定义，作为第一步。方法 指导委员会根据对风湿病学家的一项国际调查，起草了一个带有建议术语的定义。工作组对此进行了讨论和修改，包括风湿病学家、护士、卫生专业人员和患者，在面对面的会议上，直到达成足够的协议（通过投票评估）。结果 所有工作组成员都同意以下三个标准作为难治性 RA 定义的强制性要素：(1) 根据欧洲抗风湿病联盟 (EULAR) 的建议进行治疗并且 ≥ 2 种生物疾病缓解抗风湿药失败常规合成 DMARD 治疗失败后的药物 (DMARD)/靶向合成 DMARD（具有不同的作用机制）（除非有禁忌症）；(2) 存在以下至少一项： 至少中度疾病活动；提示活动性疾病的体征和/或症状；无法逐渐减少糖皮质激素治疗；快速放射学进展；导致生活质量下降的 RA 症状；(3) 体征和/或症状的管理被风湿病学家和/或患者认为是有问题的。结论 所提出的难治性 RA 的 EULAR 定义可用于临床实践、临床试验，并可为未来的研究奠定基础。