The problem of difficult-to-treat rheumatoid arthritis in real clinical practice
https://doi.org/10.33667/2078-5631-2005-28-28-33
Abstract
Difficult-to-treat rheumatoid arthritis (D2T RA) represents a complex clinical problem characterized by inefficacy of standard therapy and high disease burden. Despite the implementation of treat-to-target strategies and widespread use of biological (bDMARDs) and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs), a significant proportion of patients fail to achieve remission or low disease activity, necessitating the definition of the D2T RA category. The working group established by the European Alliance for the Treatment of Rheumatic Diseases (EULAR) proposed a clear definition of D2T RA, including three mandatory criteria: inefficacy of several bDMARDs/tsDMARDs, presence of signs of active or progressive disease, and other circumstances complicating treatment. The prevalence of D2T RA ranges from 5% to 20%, with two-thirds of patients failing to achieve adequate control, and 40% developing drug resistance. Phenotypic heterogeneity of D2T RA manifests in various subgroups: those with inadequate treatment adherence, those with comorbidities, and those with persistent inflammation. Effective management requires a comprehensive approach, including optimization of comorbid conditions, lifestyle modification, and social support. A key challenge remains early identification of patients with D2T RA to enable timely personalized therapy.
Keywords
Supporting agencies: This article was prepared as part of the research work of the V.A. Nasonova Research Institute of Rheumatology, State Assignment No. RK 125020301268–4. The study did not receive any sponsorship support.
About the Authors
E. S. Aronova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Aronova Evgeniya S., PhD Med, researcher at Laboratory of Vaccine Prevention and Comorbid Infections
Moscow
B. S. Belov
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Belov Boris S., DM Sci (habil.), professor, head of the Laboratory of Vaccine Prevention and Comorbid Infections
Moscow
G. I. Gridneva
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Gridneva Galina I., PhD Med, researcher at Laboratory of Vaccine Prevention and Comorbid Infections
Moscow
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Aronova E.S., Belov B.S., Gridneva G.I. The problem of difficult-to-treat rheumatoid arthritis in real clinical practice. Medical alphabet. 2025;(28):28-33. (In Russ.) https://doi.org/10.33667/2078-5631-2005-28-28-33
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