Elderly patients with comorbidities in the definition of difficult-to-treat rheumatoid arthritis

The advent of biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) has improved the management of rheumatoid arthritis (RA) dramatically. However, there are patients who have not been controlled adequately, and EULAR has recently proposed a definition of difficult-to-treat RA (D2T RA).1 We have verified the definition in our institution, where approximately 60% of 1700 patients with RA have been treated with b/tsDMARDs based on the EULAR recommendation and treat-to-target strategy,2 3 resulting in roughly 85% achieving target (60% in remission and 25% in low disease activity),4 5 and revealed that 10% are classified as D2T RA at the last visit.5 In the process of this investigation, we further identified 77 patients (5%) who were on the borderline of non-D2T RA despite being in moderate or high disease activity due to non-fulfilment of the criterion of failure of two b/tsDMARDs with different mechanisms of action.5 We compared the characteristics of the 77 non-D2T RA patients in moderate or high disease activity with those of the non-D2T RA patients in remission or low disease activity (table 1). The patients in moderate or high disease …