OP0139 Characteristics of difficult-to-treat rheumatoid arthritis: results of an international survey
Authors: N.M.T. Roodenrijs, M.J.H. de Hair, J.W.G. Jacobs, P.M.J. Welsing, D. M. F.M. van der Heijde, J.M. van Laar, G. Nagy
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The EULAR and ACR recommendations regarding rheumatoid arthritis (RA) mainly focus on early phases of the disease and on pharmacological management. Nevertheless, some patients remain symptomatic despite treatment according to the current recommendations, which makes them difficult-to-treat.<sup>1</sup> The estimated prevalence of difficult-to-treat RA is around 5%–20%. A difficult-to-treat RA classification needs to be defined to enable creation of recommendations on its comprehensive management. <h3>Objectives</h3> To compose a definition of difficult-to-treat RA and to explore items on its comprehensive management not covered by the current EULAR RA management recommendations. <h3>Methods</h3> An online survey was distributed among rheumatologists (in training). It consisted of 9 questions regarding the background of the respondents, aspects to be included in the definition of difficult-to-treat RA and missing items on its comprehensive management in the current EULAR management recommendations. Multiple-choice questions were used to assess the necessity of incorporating the following items into the definition: the disease activity level, e.g. the disease activity score assessing 28 joints (DAS28-ESR), presence of fatigue, number of disease-modifying anti-rheumatic drugs (DMARDs) that failed and the inability to reduce oral glucocorticoid (GC) treatment. Optional open questions were used to identify additional features for the definition of difficult-to-treat RA and to collect items on its comprehensive management not covered by the current EULAR recommendations. <h3>Results</h3> 390 rheumatologists (a few of them in training) from 31 countries completed the survey between July and December 2017 (figure 1a). 50% of the respondents would include signs suggestive of active disease or a DAS28-ESR score &gt;3.2 in the definition (figure 1b) and 41% fatigue. The most selected option for the number and category of DMARDs that had to have been used to be included in the definition was 1) Failure to ≥2 conventional synthetic DMARDs and (Boolean) 2)≥2 biological or targeted synthetic DMARDs with different mechanisms of action (figure 1c). 89% suggested including inability to taper oral GCs below 5 or 10 mg. Over 400 responses to open questions were submitted, of which a selection is listed in table 1. <h3>Conclusions</h3> This survey shows that difficult-to-treat RA is seen as a heterogeneous condition; next to signs of active disease, failure to DMARDs and inability to taper GCs may be included in the definition. The large number of respondents and of responses with regard to items not covered by the current EULAR RA management recommendations underscore the need for recommendations on comprehensive management of difficult-to-treat RA. <h3>Reference</h3> [1] de Hair MJH, Jacobs JWG, Schoneveld JLM, van Laar JM. Difficult-to-treat rheumatoid arthritis: An area of unmet clinical need. Rheumatology2017. [Available from] doi:10.1093/rheumatology/kex349 <h3>Disclosure of Interest</h3> N. Roodenrijs: None declared, M. de Hair: None declared, J. Jacobs: None declared, P. Welsing: None declared, D. van der Heijde: None declared, J. van Laar Grant/research support from: JMvL received fees from Arthrogeen, MSD, Pfizer, Eli Lilly, and BMS and research grants from Astra Zeneca, Roche-Genentech, G. Nagy: None declared