402 RA pts in RA-Paz registry, starting bDMARD betw 2000 - 2019, had 10% refractory to multiple biologics. Difficult or multi-biologic refractory Dz predicted by erosions, younger age, high baseline DAS-28, unable to lower DAS < 1.2 @6 mo (OR 11.1) https://t.co/GYJ69dgCtr