[Rheumatoid arthritis resistant to our treatments, what to do?]

Rheumatoid arthritis (RA) can be classified as « resistant » or « difficult to treat » when there is no response to multiple lines of treatment and/or persistent symptoms that reduce the patients quality of life. Resistant RA represents a high-risk population for comorbidities. These patients often have more comorbidities, more extra-articular manifestations of their RA, have more disadvantaged social backgrounds, and frequently receive fewer conventional disease-modifying antirheumatic drugs. Managing resistant RA requires a reevaluation of the mechanisms causing persistent « inflammation » or « symptoms » as well as the comorbidities and interfering conditions of the patient. Often, these patients will require optimization of both immunological and non-immunological therapies-a true challenge for clinicians.