Difficult-to-treat rheumatoid arthritis treated with Abatacept combined with Baricitinib: A case report

Table 1 European League Against Rheumatism definition of difficult-to-treat rheumatoid arthritis

EULAR definition of D2T RA
1 Treatment according to the recommendations of the European League against rheumatism, treatment failure ≥ two biological / tsDMARDs (with different mechanism)1 after csDMARD treatment failure (unless there are contraindications)2.
2 Signs indicating active/progressive diseases are defined as ≥ one of them:
(1) At least moderate disease activity (based on validated composite indicators, including joint counts, such as DAS28-ESR > 3.2 or CDAI > 10).
(2) Signs (including acute phase reactants and imaging) and / or symptoms indicating active disease (joint related or other).
(3) No reduction in glucocorticoid treatment (less than 7.5 mg / day prednisone or equivalent).
(4) Rapid radiographic progress (with or without signs of active disease)3.
(5) According to the above criteria, the disease is well controlled, but there are still RA symptoms, resulting in a decline in the quality of life.
3 Rheumatologists and/or patients believe that there are problems in the management of signs and/or symptoms.

All three standards need to appear in D2T RA.

¹Unless limited by treatment opportunities due to socioeconomic factors.

²If csDMARD treatment is disabled, it is sufficient that ≥ two biologica/tsDMARDs has a different mechanism of action.

³Rapid progress in radiographic: the change of van der Heijde-modified Sharp score ≥ five points in a year.

EULAR: European League Against Rheumatism; D2T RA: Difficult-to-treat rheumatoid arthritis; CDAI: Clinical disease activity index; cs: Conventional synthesis; DAS28-ESR: The disease activity score of 28 joints was evaluated by ESR; DMAR: Disease-modifying antirheumatic drug; RA: Rheumatoid arthritis; ts; Targeted synthetic.