What drives progression to difficult-to-treat RA? 20-year cohort 675pts -18.8% developed D2T RA -Younger age, higher HAQ & prior steroid exposure asso w/ D2T RA -Earlier b/tsDMARD initiation protective -No diff TNFi vs non-TNFi first-line strategy Disease severity and https://t.co/SJDv9HCbLv