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Researchers from the British Society for Rheumatology Biologics (BSRBR) set out to define under what circumstances will rheumatoid arthritis (RA) patients manifest biologic disease-modifying antirheumatic drugs (bDMARDs) refractory disease.
Using the patients from the BSRBR Register (2001 to 2014) they defined patients as bDMARD refractory when they initiated their third class of bDMARD.
Overall they found that 6% of 13502 RA patients were bDMARD refractory, taking a median of 8 years to receive their 3rd bDMARD.
Predictors of bDMARD refractory disease are women, those who are younger, have a shorter disease duration, higher patient global assessments, higher Health Assessment Questionnaire scores, current smokers, obesity and greater social deprivation.
This study shows that "difficult RA" or refractory RA is 1) difficult to define; 2) multifactorial; and 3) not easily or quickly achieved as it took nearly 8 years to get to this designation.
Optimal early control of RA needs to be achieved in a predictable manner. More research is needed to better define those at risk to usual or even aggressive biologic management.