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An Adoptive Transfer Model of Rheumatoid Arthritis in Mice
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Defining refractory rheumatoid arthritis.

Maya H Buch1,2

  • 1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.

Annals of the Rheumatic Diseases
|March 29, 2018
PubMed
Summary
This summary is machine-generated.

Refractory rheumatoid arthritis (RA) requires better definition. Identifying patients with persistent inflammation despite multiple biologic disease-modifying antirheumatic drugs (bDMARDs) and antidrug antibodies is key for future research.

Keywords:
dmards (biologic)rheumatoid arthritistreatment

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Area of Science:

  • Rheumatology
  • Immunology
  • Pharmacology

Background:

  • Biologic disease-modifying antirheumatic drugs (bDMARDs) have improved rheumatoid arthritis (RA) treatment.
  • A significant subset of RA patients remain refractory to multiple bDMARDs.
  • Current definitions of refractory RA are arbitrary, limiting outcome data.

Purpose of the Study:

  • To discuss the concept of refractory RA.
  • To propose principles for accurately identifying refractory RA cohorts.
  • To suggest approaches for future evaluation of refractory RA.

Main Methods:

  • Literature review and expert opinion synthesis.
  • Analysis of existing randomized controlled trial and real-world data.
  • Discussion of potential mechanisms underlying refractory disease.

Main Results:

  • Approximately 20% of RA patients may require a third bDMARD.
  • A smaller proportion fail subsequent bDMARDs.
  • Key principles for defining refractory RA include persistent inflammation and antidrug antibodies.

Conclusions:

  • Accurate identification of refractory RA cohorts is crucial.
  • Persistent inflammation and antidrug antibodies are proposed markers.
  • Further investigation into refractory RA mechanisms is needed to guide clinical practice.