The concept of difficult-to-treat disease in rheumatology: where next?

Lancet Rheumatol. 2025;7:e274–89 doi: 10.1016/S2665-9913(24)00340-0

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.

March 2021

Effects of One-Year Tofacitinib Therapy on Bone Metabolism in Rheumatoid Arthritis

Osteoporos Int 2021 Feb 9 DOI 10.1007/s00198-021-05871-0

Thought to be the first study of its kind, Hamar, et al. have demonstrated the effect of one-year tofacitinib treatment on bone mineral density (BMD) in RA patients. While the association between RA and osteoporosis is well known, and evidence indicates that up to 70% of these patients have reduced BMD, little information is available on how the JAK inhibitor tofacitinib affects bone status, areal and volumetric BMD, and bone turnover markers. In this prospective study, 30 patients were assessed...

January 2021

A significant proportion of people with RA remain symptomatic despite treatment according to current management recommendations. Different terms have traditionally been used to describe this subpopulation, including severe, refractory, resistant to multiple drugs or treatments, established and difficult-to-treat. A recent survey indicated that – in addition to new drugs – new management approaches are needed for optimal treatment in these patients.A EULAR Task Force agreed the uniform terminolog...

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