Publications

Nagy et al. propose a unifying and holistic framework for understanding and addressing the concept of difficult-to-treat (D2T) disease across rheumatology, integrating cross-disciplinary evidence and recommending its incorporation into future disease management strategies. The D2T state requires a comprehensive, holistic, multidisciplinary approach that considers the specific characteristics of each disease and the personalised needs of the patient.

This review explores the evolution of the treat-to-target approach in rheumatology and its limitations in clinical practice, which often leave a subgroup of patients inadequately managed despite appropriate treatment. The authors trace analogous developments in other chronic diseases and emphasise the variability in definitions of the D2T state across specialties, ultimately highlighting the need for rheumatology-specific criteria that reflect real-world complexity.