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Genome-wide association studies or GWAS are used to identify whether common SNPs are associated with certain diseases. Suppose specific SNPs are more frequently observed in individuals with a particular disease than those without the disease. In that case, those SNPs are said to be associated with the disease. Chi-square analysis is performed to check the probability of the allele likely to be associated with the disease.
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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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The hosts' susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against microbial attacks. When the skin is altered, the chance of infection, limb loss, and even death increases.
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When a person's physical, emotional, intellectual, social development or spiritual functioning is compromised, this deviation from a healthy normal state is called illness. Illness creates stress that in turn harms individuals. Irritation, anger, denial, hopelessness, and fear are behavioral and emotional changes an individual experiences in the phases of illness. A variety of factors influence a person's health and well-being.
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Related Experiment Video

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Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
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Factors Associated with Difficult-to-Treat Rheumatoid Arthritis (D2T-RA): Real-World Evidence from a Single-Center

Maurizio Benucci1, Francesca Li Gobbi1, Emanuele Antonio Maria Cassarà1

  • 1Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL Toscana Centro, 50143 Florence, Italy.

Journal of Personalized Medicine
|February 26, 2026
PubMed
Summary

Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) is linked to female sex, longer disease duration, and higher inflammatory markers. JAK inhibitors showed promise in stabilizing D2T-RA patients who failed other treatments.

Keywords:
b-DMARDsdifficult to treatrheumatoid arthritists-DMARDs

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Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Medicine

Background:

  • Rheumatoid arthritis (RA) is a chronic autoimmune disease causing joint inflammation and destruction.
  • Despite advancements like treat-to-target (T2T) and biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), many patients have refractory disease.
  • Difficult-to-Treat Rheumatoid Arthritis (D2T-RA) was defined by EULAR in 2021 to describe this persistent active RA.

Purpose of the Study:

  • To identify clinical, laboratory, and therapeutic factors associated with D2T-RA.
  • To understand the characteristics differentiating D2T-RA from non-D2T-RA patients.
  • To explore treatment patterns and outcomes in D2T-RA.

Main Methods:

  • Retrospective analysis of 344 established RA patients.
  • Categorization into D2T (164 patients) and NO-D2T (180 patients) groups based on 2021 EULAR criteria.
  • Analysis of clinical, laboratory, clinimetric, and therapeutic data.

Main Results:

  • D2T-RA was associated with female sex, longer disease duration, higher rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) titers, elevated erythrocyte sedimentation rate (ESR), glucocorticoid use, and more failed advanced therapies.
  • Both groups achieved low disease activity or remission by DAS28 and CDAI.
  • JAK inhibitors, specifically Filgotinib and Upadacitinib, were more common in the D2T cohort and linked to clinical stabilization.

Conclusions:

  • Disease chronicity and persistent inflammation are key factors in developing treatment resistance in RA.
  • The study identifies a predictive profile for D2T-RA.
  • JAK inhibitors demonstrate potential for stabilizing D2T-RA patients refractory to conventional and biologic DMARDs, addressing unmet needs.