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Introducing Polyrefractory RA: A New Frontier in Difficult-to-Treat RA

Jiha Lee, MD Jun 13, 2025

At a EULAR 2025 session titled “What makes ‘Difficult-to-treat RA’ so difficult to treat? And what can we do?”, Drs. Paula David and Dennis McGonagle introduced the emerging concept of polyrefractory rheumatoid arthritis (RA), a term now being used to describe a subset of patients who have failed to respond to five or more biologic or targeted synthetic DMARDs. This new classification, derived from recent multinational registry data, represents a significant step in refining our understanding and management of the most treatment-resistant forms of RA.

#Lupus is one of the biggest social discriminators 🔺️Higher prevalence in Women 🔺️Higher prevalence in Non-Whites 🔺️More catastrophic manifestations in low socioeconomic groups Disaster Medicine Session Social disparities and impact on outcomes #EULAR2025 @RheumNow https://t.co/mewR9NzXHt

https://x.com/Nellziade/status/1933840890944012624/photo/1

Migrant health literacy challenges - Individual interviews with participants with rheumatic diseases (interpreters used) multiple aspects - Individual, Providers and system level Navigating health care systems #EULAR2025 @RheumNow https://t.co/cWQ6jP8RZe

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It’s a hot topic at #EULAR2025, but the messages on AI in medicine from patient-professional discussions is clear: - potential upside massive in many domains, but - patients still want their clinicians by their side #EULAR2025 meeting highlights @RheumNow https://t.co/4T6gE7TeQp

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Great talk by @Lupusreference on Relapsing Polychondritis and a highlight of #EULAR2025. Do not forget about the articular presentations of relapsing polychondritis @RheumNow https://t.co/1xZY7VkX1z

https://x.com/synovialjoints/status/1933858987314675733/photo/1

EULAR Classification criteria for hemachromatosis, presented by Prof. Kiely shows clinical pearls in diagnosis - Hook osteophytes @MCP 2/3, & Iron Fist sign w/ elevation of MCPs 2&3. #EULAR2025 https://t.co/S8iA0C4pwG

EULAR 2025 - Day 1 Report Wednesday was Day One at EULAR 2025 in Barcelona. Thousands from around the world gathered, eager to reunite at this international educational forum. Below are a few of my favorites from Day 1. https://t.co/ycQT2dfVXe https://t.co/Qa58ofW411

EULAR 2025 - Day 1 Report | RheumNow

Health Literacy Matters in Rheumatic Disease Care Dr. Mrinalini Dey reports on abstract OP0026, "Health literacy associates with clinical, treatment and work status in people with inflammatory arthritis: Results from a national cohort", presented at EULAR 2025 in Barcelona, https://t.co/f45rxHBYnY

#TDM for #HCQ warns of #toxic #levels in #CRF v low GFR <30, <60, <90, >90 400mg/d all in low GFR toxic 200mg/d 25% in low GFR toxic 6mg/kg/d – low GFR is too ⬆️ adjust HCQ dose for pts with CRF POS0987 #EULAR2025 @RheumNow @eular_org https://t.co/vg2b87LuiE

Who/When to Treat Clinically Suspect Arthralgia Dr. Jack Cush discusses risk stratification in Clinically suspect arthralgia; referencing EULAR2025 abstracts OP0004 (ALTO study) and OP0325 (long term Followup of ARRIA) https://t.co/FCO80mdHLg https://t.co/sX9u8mUoak

Who/When to Treat Clinically Suspect Arthralgia | RheumNow

Efficacy and Safety of Xeligekimab in AS Dr. Adela Castro reports on abstract OP0102 at the EULAR 2025 meeting in Barcelona, Spain https://t.co/xpzeV0oZOr https://t.co/wmTnFbFcum

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‼️Diagnosis of axSpA is clinical -MRI is a tool but still has a lot of limitations. -Improve reports by directly communicating with radiology and be specific on pt clinical info. -Unified algorithms are needed to apply AI in dx of SIJ inflammation on MRI. #EULAR2025 @RheumNow https://t.co/9GR6FsgIcL

#EULAR2025 Take Home message from Updated EULAR Recommendations @eular_org for #Lupus Nephritis: -Kidney Biopsy vital -Early use of Combination Therapies (HCQ + GC + Immunosuppressant + CNI/Belimumab/Obinutuzumab) -Severe: High dose Cyclo + GC @RheumNow https://t.co/jHFqdT1TLf

RheumNow’s expanded coverage of the #EULAR2025 Annual meeting is sponsored in part by Johnson & Johnson and UCB. All content chosen by RheumNow & its Faculty.

Live Daily Eular 2025 Recap Day 2 https://t.co/78NYTcFPG6

Dr. John Cush

#guidelines everywhere @jeffsparks presents points of interest from #ACR #ILD #recommendations - a joint venture with American College of Chest Physicians While simultaneously the EULAR ILD recommendations are being unveiled! @RheumNow #EULAR2025 @eular_org @ACRheum https://t.co/cfHrqIAbx9

Should we screen for #lung #cancer in #SSc high risk Pts? When >10 yrs? Greek cohort of SSc since 1995 Disease duration 12 yrs, smoking lung ca group ⬆️58% vs 29% ⬆️dcSSc ⬆️immunosuppression OR >4X lung ca if dcSSc, IS Less #DU #PO0940 @RheumNow @eular_org #EULAR2025 https://t.co/L2zEkP8pAc

Some RA-ILD is less of a worry, some is critical. How do we stratify? Great modelling work from Korea & @jeffsparks - model stratifying really well, even without KL-6. We need to do this more, so we can go really hard early when we need to. #EULAR2025 OP0329 @RheumNow https://t.co/i2djatO3F2

https://x.com/drdavidliew/status/1933462421408264623/photo/1

🌍Patients w RMDs across 🇫🇷🇳🇱🇨🇭🇹🇷 face different barriers to physical activity: 💶Cost =barrier in 🇳🇱 ⛈️Weather =barrier in 🇹🇷 🧑‍⚕️HCP support =key in 🇫🇷 🏃Active transport & knowledge =enablers in 🇨🇭 Tailored physical activity interventions needed. @RheumNow #EULAR2025 #OP0382-HPR https://t.co/lk7fwDHDe7

https://x.com/DrMiniDey/status/1933463606147899562/photo/1

PsO + recent arthralgia—but no PsA. Treat or wait? 🧠 18% developed PsA in 3 yrs, most in year 1 🔍 Predictors: tender joints, disability, enthesis erosion Consider early rheum input for these patients Abstract POS0299 @RheumNow #EULAR2025

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Introducing Polyrefractory RA: A New Frontier in Difficult-to-Treat RA

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